The World Bank may approve a $250m loan to Nigeria next month under the third phase of its Health Security Programme in Western and Central Africa as the country battles mounting health and economic challenges.

According to an appraisal document published by the global lender, the proposed loan, which is scheduled for board approval on September 23, 2025, will be channelled towards improving Nigeria’s ability to prevent, detect and respond to health emergencies through strengthened systems and regional collaboration.

The World Bank document noted that the objective of the loan project is to “increase regional collaboration and health system capacities to prevent, detect and respond to health emergencies in the Federal Republic of Nigeria.”

The funding, which will come in the form of an International Development Association credit, is expected to be managed by the Nigeria Centre for Disease Control, with the Federal Ministry of Finance serving as borrower.

According to the World Bank document, Nigeria, Africa’s most populous nation with an estimated 223 million people, is facing some of the worst health outcomes globally. Life expectancy remains at a low 54 years, maternal mortality exceeds 1,000 per 100,000 live births, and under-five mortality is 114 per 1,000.

These translate to over 800,000 child deaths and 80,000 maternal deaths annually. The country’s health system is further strained by the growing threat of antimicrobial resistance, which was directly responsible for more than 64,500 deaths in 2019 and associated with over 263,000 others.

Six of Nigeria’s top ten causes of death are infectious diseases, including malaria, HIV and AIDS, tuberculosis and diarrhoeal diseases. These public health concerns are compounded by widespread poverty, weak infrastructure, underfunding and poor human capital development.

The World Bank estimates that 120 million Nigerians, or 54 per cent of the population, were living below the poverty line in 2024. Despite its health crisis, government expenditure on healthcare remains one of the lowest globally at just 0.62 per cent of GDP and 4.1 per cent of general government spending.

This translates to approximately $14 per capita, with less than $3 of that allocated to primary healthcare. As a result, out-of-pocket health spending by households reached 76.24 per cent in 2021, ranking among the highest in the world and severely limiting access to care for millions of Nigerians.

Compounding these challenges is the growing frequency of climate-related disasters, which are predicted to cause $399bn in health-related economic losses by 2050, according to World Bank estimates.

The proposed $250m health facility will be used to improve disease surveillance, laboratory capacity, emergency preparedness and health service continuity during outbreaks.

The project will also expand public health infrastructure, including emergency operations centres across Nigeria’s 36 states and the Federal Capital Territory, and develop a national warehouse for emergency medical supplies.

Part of the funds will also support Nigeria’s efforts to improve pharmaceutical regulation and stimulate local manufacturing of essential medicines in partnership with agencies such as the National Agency for Food and Drug Administration and Control and the National Institute for Pharmaceutical Research and Development.

The World Bank document reveals that Nigeria’s public health response remains fragile despite some improvements. While the country’s overall score in the 2023 Joint External Evaluation of International Health Regulations core capacities rose to 54 per cent from 39 per cent in 2017, significant gaps persist.

Legal frameworks remain inadequate, detection capacity is geographically limited, and logistics for emergency response are weak, especially at the subnational level. Surveillance systems remain fragmented, and critical veterinary and environmental health services lack coordination and funding.

The project aims to improve collaborative surveillance systems by integrating platforms such as the Surveillance Outbreak Response Management and Analysis System for human health and the National Animal Disease Information System for animal health.

Investments will also be made in ICT equipment, training and community-based health services, particularly at the local government level. The initiative will seek to enhance women’s participation in epidemiological training and leadership in response to the gender disparities revealed during past health emergencies such as the Ebola and COVID-19 outbreaks.

While the loan proposal is being finalised, the environmental and social risk of the project has been rated as substantial. Implementation will be coordinated by the NCDC through a National Project Coordination Unit with oversight from a National Steering Committee chaired by the Coordinating Minister for Health and co-chaired by the Ministers of Finance, Environment and Livestock Development.

At the state level, a similar structure will be established, led by the State Commissioner for Health and supported by local coordination units. Only states that meet eligibility requirements, including formal expressions of interest, counterpart funding, and adoption of national health security policies, will be allowed to participate.

Meanwhile, data from the Debt Management Office showed that Nigeria’s total debt to the World Bank rose to $18.23bn as of March 31, 2025. This marks a $420m increase in just three months since December 2024, when Nigeria’s total exposure to the World Bank stood at $17.81bn.

The DMO data showed that borrowings from the International Development Association, the concessional financing arm of the World Bank, rose from $16.56bn in December 2024 to $16.99bn in March 2025.

At the same time, loans from the International Bank for Reconstruction and Development — the non-concessional lending window of the World Bank — remained unchanged at $1.24bn. In total, the World Bank Group now accounts for $18.23bn, or about 39.7 per cent of Nigeria’s total external debt stock, which stood at $45.98bn as of March 2025.

This reflects a marginal increase in the World Bank’s share of the debt portfolio, up from 38.9 per cent recorded in December 2024 and 36.4 per cent at the end of 2023. Further analysis indicates that the World Bank now constitutes 81.2 per cent of Nigeria’s total multilateral debt, which reached $22.43bn in Q1 2025.

This represents a rise from the 79.8 per cent share recorded at the end of 2024 and underlines the central role the institution continues to play in Nigeria’s financing framework.