"The World Bank set out to transform health care for the poor in Africa. It drove patients deeper into poverty", July 8, 2025

Jacob Njagi’s newborn son could barely breathe when he arrived in an ambulance at the emergency ward of an Avenue Group hospital in Nairobi, Kenya, in the early hours of the morning. It was June 2022 — COVID-19 cases were surging — and Njagi and his family had spent hours searching for an available bed... Njagi was exhausted. His infant, Jason, was in peril, his lungs clogged. But Njagi said that administrators at the hospital — which is backed by the International Finance Corp. (IFC), a member of the World Bank Group that works to relieve poverty — demanded a deposit. “We had to beg them to at least give us oxygen, because the oxygen in the ambulance was almost out,” Njagi recently told the International Consortium of Investigative Journalists (ICIJ). Admission, he learned, required a deposit of 100,000 Kenyan shillings (about $850 at the time) — more than a month’s income from the wholesale foods business he’d built. Njagi scrambled for funds, begging his sister for assistance. Her friends helped scrape together enough to cover a deposit for the baby, he said. Nearly a week later, Jason was well enough to go home, but he had spent three days on a ventilator in the neonatal intensive care unit and needed further treatment, the doctors warned. Njagi, who is 34, was concerned that he could never pay the bill — already more than 400,000 shillings (about $3,600) — so he asked for his son to be discharged. Jason’s care had come at an almost unbearable cost: the financial stability Njagi had built for his family.

In Kenya, where only about a quarter of the population was insured in 2023, health care is scarce and often ruinously expensive. But the IFC-backed hospital that treated Njagi’s son was supposed to be different. One of five institutions that make up the World Bank Group, the IFC’s mission is to fight poverty in developing nations by investing in the private sector, a task supported with funds from its more than 180 member countries. Its investment in Avenue Group, the company that runs the hospital where Njagi’s son was treated, was intended to advance the World Bank Group’s health care strategy, which includes helping families in the developing world avoid “poverty due to illness.” Instead, IFC-backed, for-profit hospitals like those run by Avenue Group have destabilized the finances of families across East Africa, a year-long investigation by ICIJ has found. Avenue Group’s operator, the Evercare Group, said that its hospitals and clinics provide “access to quality care for many poor and lower income Kenyans” and that it does not make emergency care contingent on a patient’s ability to pay upfront. Since 2009, the IFC has partnered with at least four private equity firms that have invested its money in for-profit hospitals in Kenya and Uganda. While the IFC has made public promises to improve health care for everyone, its financing for private hospitals in East Africa has instead deepened inequality. It has also contributed to the tens of millions of dollars in management fees and financial performance bonuses paid to private equity firms for their work managing investments in hospitals on behalf of the IFC and others. In over 70 interviews, former and current doctors, nurses and executives from IFC-backed facilities in Kenya and Uganda and from the private equity firms managing them described how pressures to improve returns for investors contributed to increased treatment costs and reduced accessibility. This saddled some patients with crushing debt and diverted resources originally intended to help the poor toward making medical facilities more profitable. These accounts are supported by court records, internal corporate communications and documents, and patient records reviewed by ICIJ. To collect unpaid bills, some of the hospitals unlawfully detained patients up to months at a time, ICIJ found. Some of these incidents were widely reported in the media and were the subject of high-profile court cases and government inquiries. But the IFC failed to prevent problematic practices from continuing at hospitals it helped finance. And the organization has continued backing private hospitals even as it has remained unclear whether the investments increase accessibility or affordability for the poor in any meaningful way.

The IFC did not answer detailed questions from ICIJ about allegations of patient mistreatment or aggressive efforts to collect payments at the hospitals it funds. It said that the IFC “advocates for improved financial protection for citizens,” adding that its client hospitals try to help low-income patients but people still struggle because many countries’ public health care systems aren’t sufficiently funded. The organization also said that it expects the hospitals to inform the IFC and other relevant authorities of credible allegations of wrongdoing, and that when necessary the hospitals should strengthen internal controls. “We can and must do better in our oversight and supervision,” the IFC said in its statement, adding that, going forward, it “will not work with new clients who do not commit to — and follow — our standards, and ethical principles and practices for patient care.” Bloomberg News and the anti-poverty organization Oxfam have both also recently reported on the high cost of care and problematic practices at IFC-financed hospitals. Evercare, Avenue Group’s operator, also said that “it is not our policy to detain patients for non-payment.” It noted the “robust financial counselling programs” and “flexible payment solutions” it provides to patients and also said it has introduced care protocols that include an express prohibition on detentions…