Nigeria’s private healthcare providers have raised concerns over what they describe as their exclusion from discussions on implementing a proposed $5 billion Nigeria-United States healthcare partnership, warning that the lack of transparency and stakeholder engagement could undermine one of the country’s most ambitious health sector reform initiatives.
The concerns come after BusinessDay reported that the U.S. Department of State is seeking project proposals for what could become one of its largest health transformation programmes in Africa’s most populous country. Under the initiative, up to $200 million will be made available to support Nigeria’s transition to a more self-reliant healthcare system over the next five years.
The funding opportunity, announced by the Bureau of Global Health Security and Diplomacy (GHSD), forms part of the implementation of a Health Memorandum of Understanding (MoU) signed by the U.S. government and the Federal Republic of Nigeria in December 2025.
The programme, expected to run through 2030, could support up to 20 projects, subject to the availability of funds. Unlike previous donor-funded interventions focused on specific diseases, the new framework seeks to strengthen Nigeria’s entire health system while gradually shifting responsibility for financing and programme delivery to Nigerian institutions.
However, private healthcare stakeholders say they know very little about how the initiative will be implemented despite its potential to reshape healthcare delivery in the country.
Their concerns are not about the size of the funding, but about the secrecy surrounding the implementation framework, privacy, uncertainty over who is eligible to participate, and fears that Nigeria could once again become dependent on a donor-backed programme that struggles to deliver lasting impact after external funding ends.
The issues emerged during a high-level healthcare discussion involving senior private sector healthcare executives, development partners and industry stakeholders, all of whom requested anonymity because they were not authorised to speak publicly on the matter.
$5 billion deal, but little information
The concerns of the private sector healthcare players stem from uncertainty over who can participate and fears that Nigeria may once again become dependent on a donor-driven programme that fails to survive after foreign funding ends.
The agreement, signed in December 2025, marks a major shift in how the United States intends to engage developing countries after dismantling USAID as an independent agency and moving foreign assistance under the U.S. State Department.
Unlike the previous donor model, where programmes were largely financed by the United States, the new framework requires partner countries to contribute significant funding.
According to multiple people familiar with the deal, the total funding window is valued at $5 billion, comprising $2 billion from the United States and $3 billion from Nigeria.
The new model aims to move away from grants that fund conferences, consultants and multiple intermediaries. Instead, it seeks to attract American companies to work with local partners to build commercially sustainable healthcare businesses.
However, despite the significance of the agreement, sources said almost no one outside the core negotiating team has seen the detailed implementation framework.
‘We assumed that organisations intending to participate would at least be able to understand the government’s priorities. Instead, neither side has been willing to share basic details,’ one of the sources, who did not want to be quoted as the matter is not in public, said.
Private sector says it was left out
Another senior healthcare executive said the lack of engagement with Nigeria’s private healthcare sector was troubling.
The executive said several Nigerian organisations had already been approached by foreign companies seeking partnerships under the programme.
However, uncertainty remains over whether only American companies can access the funding directly or whether Nigerian firms can also apply independently.
‘There is still considerable confusion. The application window closes at the end of July, yet many stakeholders still don’t understand how the programme will work,’ the source stated.
American companies appear to have the first advantage
A private healthcare investor who participated in the discussion said American companies appeared to have started identifying Nigerian implementation partners before many local organisations even became aware of the opportunity.
‘One company on whose board I serve was approached by an American consulting firm looking for local partners. That reinforces the perception that this remains very much an ‘America First’ programme, with American firms leading while Nigerian organisations largely serve as implementation partners.’
The investor also questioned whether the initiative genuinely differs from previous donor-funded interventions, stating: ‘The themes have largely been predetermined. There has been very little engagement with local stakeholders to identify Nigeria’s most pressing healthcare priorities.’
A shift from aid to business
The new U.S. approach appears fundamentally different from traditional development assistance.
The objective is no longer to provide endless donor funding but to create commercially viable healthcare businesses capable of surviving after American support ends.
‘The idea is that after two or three years, these businesses should stand on their own financially. The U.S. subsidises the initial setup, but not indefinitely,’ a source familiar with the matter said.
The model, according to the source, also compels governments to invest more of their own resources rather than relying on foreign donors.
Why sustainability remains a concern
Despite acknowledging the potential benefits, several healthcare leaders warned that Nigeria has seen similar promises before.
One executive with nearly two decades of experience in Nigeria’s health sector said many donor-funded programmes performed well while foreign funding lasted but struggled once donors exited.
‘In nearly twenty years of working in this sector, that has been the recurring experience.’
‘Funding comes for a few years, the projects operate, the donors leave, and then we start almost from scratch again,’ the executive said.
Nigerians still pay for most healthcare
Nigeria’s health financing challenges are well documented.
Nearly 70 percent of healthcare spending is still paid directly by patients, while only around 10 percent is financed through health insurance.
Government spending accounts for roughly 20 percent of health financing, with a significant share historically supported by foreign development assistance.
Experts say that unless Nigeria significantly increases domestic investment, dependence on donor funding will persist.
Health data becomes another concern
Health data is becoming one of the world’s most valuable commercial assets as pharmaceutical companies increasingly seek clinical information from African populations to develop new medicines.
Africa’s growing population makes the continent strategically important for future medical research.
However, experts say that while funding is welcome, strong regulatory safeguards are needed to protect Nigerians’ medical information.
They point to past controversies surrounding clinical research in Nigeria as evidence that the government must strengthen oversight and ensure transparency.
Why Kenya pushed back
The concerns being raised in Nigeria mirror debates that recently emerged in Kenya over a similar U.S. health cooperation framework.
In Kenya, civil society organisations and legal activists challenged aspects of the proposed arrangement, arguing that it could expose sensitive health information and biological data without sufficient safeguards. They questioned whether Kenyan citizens had been adequately consulted and whether the country retained full control over its health data.
The controversy triggered public debate over data sovereignty, informed consent and national oversight of foreign-funded health programmes. Kenyan authorities subsequently slowed aspects of the initiative and faced increasing pressure to clarify the terms of engagement before implementation proceeded.
Healthcare experts say the Kenyan experience demonstrates that while countries urgently need external investment to strengthen their health systems, governments must also ensure transparency, protect citizens’ health data and involve local stakeholders from the outset.
For many Nigerian healthcare leaders, those same questions remain unanswered.
They insist that while the $5 billion partnership could significantly strengthen healthcare delivery, its success will ultimately depend not only on the amount of money available but also on transparency, government ownership, meaningful participation by local healthcare providers and clear safeguards for Nigerians’ health data.
Without those elements, they warn, the programme risks becoming another well-funded initiative that delivers short-term gains but leaves little lasting impact once donor support comes to an end.