Nigeria’s House of Representatives has launched a sweeping investigation into the utilization of over $4.6 billion in health grants from the Global Fund and USAID, plus an additional $6 billion from PEPFAR, earmarked for combating HIV, tuberculosis, and malaria. This move comes amidst mounting concerns that, despite these massive financial inflows, Nigeria continues to bear an unacceptably high global burden of these diseases, prompting calls for urgent transparency and accountability.
In a significant move towards ensuring accountability in the nation’s health sector, the Nigerian House of Representatives has initiated a comprehensive probe into the management of substantial international health grants. This investigation targets over $4.6 billion received from the Global Fund and the United States Agency for International Development (USAID) between 2021 and 2025, intended to bolster Nigeria’s fight against HIV/AIDS, tuberculosis (TB), malaria, and polio.
The decision, which followed the adoption of a motion sponsored by Hon. Amo Ebi Ogah and presented by Hon. Philip Agbese during plenary on Tuesday, October 21, 2025, underscores a growing concern among lawmakers. Despite being one of the largest recipients of health assistance in Africa, Nigeria continues to grapple with some of the highest disease burdens globally, raising serious questions about the effectiveness and transparency of grant utilization.
The Alarming Statistics: A Deep Dive into Nigeria’s Health Crisis
Hon. Philip Agbese highlighted the stark reality of Nigeria’s public health landscape. In 2023 alone, approximately 15,000 AIDS-related deaths occurred among Nigerian children aged 0-14, with a total of 51,000 AIDS-related deaths recorded nationwide. These figures position Nigeria as the third globally in HIV deaths and the country with the highest number of HIV cases in West and Central Africa.
The challenges extend beyond HIV/AIDS. Nigeria holds the unenviable position of being first in Africa and sixth globally in tuberculosis prevalence, accounting for a staggering 4.6% of the global TB burden. Furthermore, the nation bears the highest malaria burden worldwide, responsible for 26.6% of global malaria cases and a devastating 31% of global malaria deaths. These statistics are available from organizations such as the World Health Organization, which tracks global health data.
Billions in Aid: Understanding the Funding Landscape
The scale of international assistance to Nigeria’s health sector is immense. Between 2021 and 2025, Nigeria received an estimated $1.8 billion from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This fund, established in 2002, aims to accelerate global efforts against these epidemics, particularly in sub-Saharan Africa. Additionally, the country received $2.8 billion in health assistance from USAID between 2022 and 2024, covering various health threats, including HIV, malaria, polio, and tuberculosis.
Beyond these, Nigeria also benefited from over $6 billion in aid from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) from 2021 to 2025, specifically for HIV/AIDS control and strengthening health systems across the country. Detailed information on these initiatives and funding can often be found on official platforms like the USAID Nigeria Health page.
The Federal Ministry of Health and Social Welfare is primarily responsible for implementing USAID-funded projects, while the Country Coordinating Mechanism (CCM) Nigeria oversees Global Fund programs. The critical question posed by lawmakers is why, despite these substantial investments, the nation’s health outcomes remain so dire.
The Oversight Deficit: Constitutional Mandate and Accountability
A key concern raised by Hon. Agbese is the perceived lack of “coordinated and robust oversight” by the National Assembly over the implementers of these grants. He cited Sections 88 and 89 of the 1999 Constitution (as amended), which empower the legislature to summon any ministry, agency, or non-governmental organization for accountability purposes.
Reports have historically highlighted issues within Nigeria’s health system regarding donor fund management, including “weak accountability frameworks, fund leakages, and delays in programme implementation.” This probe aims to address these systemic issues head-on. The House has mandated its Committee on HIV/AIDS, Tuberculosis and Malaria Control to investigate the utilization of the grants and report back within four weeks for further legislative action. Additionally, the Coordinating Minister of Health and Social Welfare has been directed to provide the implementation plan and the National Assembly-approved expenditure details of these grants.
Risking the Future: SDGs and Global Fund Replenishment
The lawmaker issued a stern warning: if the current situation persists, Nigeria risks failing to meet the United Nations Sustainable Development Goal (SDG) target of eliminating HIV, TB, and Malaria by 2030. This target, specifically SDG 3.3, calls for ending the epidemics of these diseases. The lack of effective utilization of funds not only jeopardizes public health but also threatens Nigeria’s standing in the international community.
Furthermore, without urgent scrutiny and restructuring, Nigeria may miss out on the 8th replenishment cycle of the Global Fund, which provides crucial support to countries committed to eradicating these diseases. The potential loss of future funding could severely cripple ongoing and planned health initiatives, perpetuating the cycle of high disease burden and mortality.
Conclusion: A Path Towards Accountability
The House of Representatives’ investigation marks a critical juncture for Nigeria’s health sector. It represents a determined effort to enforce transparency, strengthen accountability, and ensure that the billions of dollars in international aid translate into tangible improvements in public health outcomes. The outcome of this probe will not only determine the fate of current health programs but also shape Nigeria’s capacity to achieve vital global health targets and secure future international support.
