The overgrown grasses are the first sign of neglect at Agbinpa Primary Healthcare Centre in Ede South Local Government Area of Osun State. They cover parts of the compound, brushing against walls with peeling paint and deep cracks. Sections of the facility have become unusable, while others have fallen into disrepair after years without major rehabilitation.

Next to the health centre stands a staff quarters commissioned in March 1999, a reminder of how long the facility has served the community and how little has changed over the years.

Getting to the facility was difficult. It took this reporter about an hour on a commercial motorcycle from Osogbo to Agbinpa, travelling along long stretches of uneven rural roads.

It was in late May, and Rashidat Lamidi was attending to patients. For years, she has run the health centre as its sole caregiver and administrator. Mrs Lamidi attends to pregnant women, children, and other patients, responds to emergency calls even after leaving work, clears the surroundings and, at times, buys basic consumables when they are out of stock.

“Even if I’m at home and somebody comes to call me because a child is sick or a woman wants to give birth, I will come,” she said.

Mrs Lamidi said the state government pays her salary regularly. But it does not extend the same attention to the facility, despite many politicians and government officials visiting over the years, particularly during election periods.

“They come here, but they don’t do anything.”

The impact of the deteriorating infrastructure extends beyond the building itself.

Because the facility has no functional laboratory, patients who need basic blood tests have to travel about 26 kilometres to Ede. Although a few delivery instruments were available during PREMIUM TIMES’ visit, they were inadequate for the number of patients the facility serves. Women in labour buy gloves for the nurse and buy methylated spirit and other consumables before receiving care.

As the only official, Mrs Lamidi is concerned about the health centre’s future after her retirement.

“I don’t know what will happen to this place,” she said.

Residents count the cost

The poor condition of the PHC has not diminished its importance for the residents of Agbinpa. It has only made healthcare harder to access and more expensive.

Iya Beji, a woman who gave birth to each of her five children at the facility, praised the commitment of the lone nurse.

“The nurse is good. It is only because of the condition of the hospital that people do not come here,” she said.

According to the woman, patients who need scans are referred to Ede, where transport alone costs about N6,000.

“If someone is sick, what can we do? We have to go.”

Abdulrahaman Babatunde, another resident, said commercial motorcycles rarely use the route because of its condition.

“If you hire a bike, it can cost N6,000,” he said. “If the rider waits for you, they charge as much as N10,000.”

Mr Babatunde said farmers also suffer when taking produce to nearby markets, limiting economic activity in the community.

Electricity is another challenge for the locals. Private operators of solar charging points charge between N400 and N700 to charge their phones or power banks.

“There has been no light here for a long time,” Mr Babatunde said. “The poles and wires are still there, but there is no electricity.”

Another community, another barrier

About an hour’s ride from Osogbo, Abudo PHC in Egbedore LGA presents a different, but equally troubling picture.

Here, the biggest obstacle to healthcare begins long before patients reach the facility.

The road to the community is so bad that commercial motorcyclists avoid it. When this reporter arrived around 1 p.m., the facility was locked.

Through dusty louvre windows, patient registers and other documents could be seen scattered across the rooms. Cobwebs hung from parts of the building, suggesting some sections had remained unused for some time.

No health worker was on the premises. Instead, telephone numbers had been written on a wall for anyone who needed them to call.

This reporter dialled the numbers repeatedly, but the calls either failed to connect or the phones were switched off.

Chief Alao, a community leader, said Abudo’s PHC serves the community as well as several neighbouring settlements.

He said years of poor road infrastructure have isolated the area, affecting access to healthcare and residents’ livelihoods.

“This road was not constructed by the government,” he said. “The community did it ourselves, although there are still many potholes.”

Kemi Olawole, a palm kernel processor, said the facility refers patients whom they cannot manage to a health facility in Ede, about 16km from Abudo.

Ms Olawole added that residents now depend on a vendor who transports orthodox medicines into the community on a motorcycle because there is no pharmacy in Abudo. 

Without him, she said, many residents would have to travel outside the community to buy essential medicines.

For another resident, Kehinde Olumide, who also works in the palm kernel oil trade, transportation remains one of the community’s biggest challenges.

“We hardly see motorcycles here,” he said. “And when you get one, it is very expensive because of the road.”

A renovated facility, familiar problems

About 36 kilometres away, in Ekusa, Odo-Otin LGA, residents said the community’s PHC was renovated in 2020.

An inscription on the building states that the project was carried out by the Odo-Otin Local Government and commissioned on 15 March 2020.

But six years later, many of the problems affecting healthcare delivery remain in the community.

When PREMIUM TIMES visited the facility, parts of the premises were overgrown with weeds. The hospital’s borehole was not functioning.

Unlike Agbinpa, where the lone nurse openly discussed the facility’s challenges, health workers in Ekusa declined to speak. One who requested anonymity said they were not permitted to comment on issues relating to PHCs.

“Many people have come here asking questions,” she said. “If it is something I cannot talk about, it is better I don’t say anything. During our meetings, we are always told that if anyone asks questions about PHC, we should refer them to the appropriate authorities.”

She directed this reporter to the Osun State Primary Health Care Development Agency, explaining that decisions regarding the facility were handled centrally.

Residents later explained that health workers’ reluctance to speak was not unusual. According to them, the facility typically closes around 4 p.m. Patients who arrive later have to wait until the next day or travel to another community for treatment.

A woman who identified herself as Mojisola said residents seek treatment elsewhere whenever the facility cannot meet their medical needs.

Abdulrahaman Wasiu, a spiritual and youth leader in the community, said nothing had changed since the 2020 renovation. 

“People only came to paint the building,” he said. “Apart from that, nothing much changed.”

Pointing to his hand, which he said had once suffered a dislocation, Mr Wasiu recalled visiting the health centre for treatment but leaving without receiving the care he needed.

According to him, the facility has existed for as long as he could remember, but has remained chronically understaffed.

When Mr Wasiu accompanied this reporter back to the facility, they met another man wearing an “Imole cap” who identified himself as a supporter of Governor Ademola Adeleke. He confirmed the health workers’ gag and that enquiries should be directed to the Osun State PHCDB.

While acknowledging that the facility required attention, he said Governor Adeleke would intervene if he became aware of its condition.

Following the money

The problems observed during PREMIUM TIMES’ visits suggest that, despite years of government investment and prior reporting highlighting similar concerns, many of the challenges facing health facilities remain unresolved.

The conditions at Agbinpa PHC stand in sharp contrast to the Osun State government’s growing financial commitment to healthcare.

Between 2020 and 2026, the state budgeted about N157.74 billion for the health sector, according to an analysis of approved budget documents by PREMIUM TIMES.

In 2020, the state approved N7.2 billion for health, representing 6.02 per cent of the N119.55 billion budget. The allocation rose to N9.8 billion (8.93 per cent) in 2021 and N12.4 billion (9.56 per cent) in 2022.

Health spending reached N17.92 billion, representing 12.96 per cent of the state’s N138.27 billion budget in 2023, the highest proportion recorded during the review period.

Although the percentage later declined, the nominal value of health allocations continued to increase. The state budgeted N18.6 billion for health in 2024, N32.58 billion in 2025 and N59.24 billion in the approved 2026 budget.

Budget implementation data reviewed by PREMIUM TIMES also points in the same direction.

According to BudgIT’s State of States reports, Osun’s capital expenditure rose from N18.7 billion in 2020 to N118.4 billion in 2024. The reports also show that actual health expenditure increased from N10.6 billion to N17.7 billion over the same period, while the Ministry of Health and Human Services recorded improved performance ratings.

On paper, the figures indicate an increase in public investment in healthcare. The question, however, is how those investments have translated into community-level services.

To answer that, PREMIUM TIMES examined procurement records published by the state government.

Procurement records

The records show that between 2020 and 2024, the Ministry of Health awarded contracts worth hundreds of millions of naira for the renovation of health facilities, the procurement of medical equipment, the installation of solar power systems, the repair of boreholes, and other primary healthcare projects.

In 2020, the ministry awarded a N35.7 million contract to Olupopson Nigeria Limited for the rehabilitation and upgrading of General Hospital, Ifetedo. It also approved N6.8 million for the procurement of 4,000 cartons of noodles, with both projects listed as completed on the state’s procurement portal.

The following years saw continued spending on medical equipment, including theatre lamps and diathermy machines, X-ray machines, instrument trolleys, suction machines, emergency stretchers, ultrasound scanners, ECG machines, hepatitis B testing kits, HIV/AIDS consumables, laboratory supplies, computer systems, and other surgical equipment. 

Most of the contracts reviewed by PREMIUM TIMES were marked as completed, while a few remained active or had no completion status.

The largest investments reviewed during this investigation were recorded in 2024.

Procurement records show that the state awarded multiple contracts valued at between N426 million and N592 million for the renovation of PHCs across  the state’s three senatorial districts.

Separate contracts worth more than N188 million each were also awarded for the supply and installation of solar power and inverter systems across the three districts, while additional contracts ranging from N119 million to N556 million were approved for the sinking and repair of boreholes.

At the time PREMIUM TIMES reviewed the records, many of the 2024 projects were still listed as “Active” on the state’s procurement portal.

However, the procurement documents do not identify the individual PHCs covered under the various phases of the projects.

As a result, PREMIUM TIMES could not independently verify whether Agbinpa PHC in Ede South, Abudo PHC in Egbedore or Ekusa PHC in Odo-Otin were among the facilities selected for renovation, solar installations or borehole projects.

Statements by government

Throughout the period covered by this investigation, the state government maintained that strengthening primary healthcare remains one of its priorities.

During an inspection of renovated PHCs in Telemu, Ola-Oluwa LGA, and Ido-Osun, Egbedore LGA, in March 2025, Governor Adeleke said his administration was committed to improving access to healthcare, particularly for residents of rural communities.

According to the governor, the state embarked on the rehabilitation and upgrading of PHCs to strengthen healthcare delivery at the grassroots level.

“I am glad that our people are now benefiting from the outcome of the upgrade and renovation of the health centres. I assure Osun people that we will not relent on the upgrade of our health facilities,” Mr Adeleke said.

He added that the government was prioritising improvements at the primary healthcare level before extending interventions to secondary and tertiary facilities, arguing that stronger primary healthcare would enable earlier detection and treatment of illnesses.

In his third anniversary broadcast in November 2025, the governor also said his administration had rehabilitated more than 200 PHCs across the state.

According to him, the projects included structural rehabilitation, clean water systems, perimeter fencing, roofing repairs, furniture, sanitation facilities, and solar power. He added that another phase covering nearly 200 additional facilities was already underway.

The governor also highlighted the revitalisation of the Osun Health Insurance Scheme, expanded insurance coverage, free surgical interventions across the state’s nine federal constituencies and a $500,000 performance award for the state’s progress on universal health coverage indicators.

Yet, in the three communities visited, this reporter found deteriorating health infrastructure, limited services, staffing shortages and difficult access to healthcare, suggesting that, for some rural communities, the benefits of the state’s healthcare investments remain difficult to see.

Government cites funding constraints, ongoing reforms

PREMIUM TIMES contacted the Osun State Primary Health Care Development Agency on the findings.

In a telephone interview, the agency’s Executive Secretary, Adesina Igbalaye, repeated that the state had invested significantly in primary healthcare.

He said the agency conducts routine monthly and quarterly assessments of health facilities to monitor infrastructure, staffing, equipment, and service delivery, with the reports used to identify facilities requiring intervention.

According to him, the government adopted a strategy of upgrading one focal PHC in each ward.

The selected facilities, he said, received renovations, solar power systems, boreholes, medical equipment and other improvements intended to strengthen healthcare delivery.

Mr Igbalaye also said the government introduced stipends for volunteer health workers who had previously served without pay and provided counterpart funding for health programmes implemented with development partners.

Responding to PREMIUM TIMES’ findings that the facilities visited lacked basic services, he said the ongoing revitalisation programme was designed to prioritise one focal facility in each ward while other centres continued to provide routine services.

He attributed delays in extending improvements to all facilities to funding constraints.

According to him, implementation of parts of the programme slowed after disputes over local government administration affected access to local government funds beginning in February last year.

He said the funding challenge affected the pace of ongoing projects, although work has continued in some facilities through other government interventions, including drug supply and routine support for primary healthcare services.

Mr Igbalaye added that the agency’s assessments have enabled it to identify infrastructure and service gaps across facilities, insisting that the government remains committed to improving access to primary healthcare across the state.

Agency report echoes field findings

PREMIUM TIMES requested records of the PHCs revitalised under the state’s programme, the criteria used to select focal facilities and the agency’s most recent assessment reports.

Mr Igbalaye provided a copy of the board’s “5-Day Routine Quarterly Quantitative Integrated Supportive Supervision at PHCs in 15 Selected LGAs” report for the second quarter of 2026.

The report, prepared by the board’s Directorate of Planning, Research and Statistics, said supervision teams visited at least 150 PHC facilities across 15 selected LGAs between 1 and 5 June 2026.

The exercise assessed health facility infrastructure, staffing, service delivery, medicine availability, immunisation performance, maternal and child health indicators, and data quality.

However, the report did not identify the 15 LGAs assessed or list the facilities visited.

It also did not provide facility-level findings, making it impossible to independently determine whether Agbinpa, Abudo and Ekusa were among the facilities assessed or how each performed during the exercise.

Even so, the report acknowledged many of the challenges residents described during this investigation.

It identified shortages of health workers, stock-outs of essential medicines and consumables, absenteeism among some health workers, poor record-keeping, and difficult road conditions that affect access to some rural facilities.

The report stated that stock-outs of malaria medicines were recorded at 50 facilities, while 20 facilities lacked oral rehydration salts (ORS), a basic treatment for managing diarrhoea.

It also noted that difficult road conditions during the rainy season affected access to some rural PHCs, while shortages of human resources remained a challenge across the system.

Among its recommendations, the board called for the procurement of essential medicines and consumables, the conversion of ad hoc and volunteer health workers to permanent staff, improved monitoring of staff attendance, and increased funding for supervision activities.

‘Buildings alone do not make PHCs functional’

The conditions documented by PREMIUM TIMES point to broader weaknesses in Nigeria’s primary healthcare system, where investments in infrastructure do not always translate into accessible, quality healthcare, according to Sheriff Gbadamosi, Advocacy and Community Engagement Manager at Nigeria Health Watch.

Mr Gbadamosi said PHC is meant to be the first point of contact with the health system. When residents travel long distances for services that should be available in their communities, he said, it raises questions about whether public investments are delivering the intended results.

“Access should not be measured by the presence of a building alone,” he said. “It should be measured by whether facilities are adequately staffed, stocked with essential medicines and equipped to provide basic services.”

He noted that while renovating health facilities is important, infrastructure alone cannot improve health outcomes.

According to him, the experiences documented in Agbinpa, Abudo and Ekusa reflect wider challenges facing Nigeria’s PHCs system, including workforce shortages, weak supply chains, financing gaps and governance issues.

Mr Gbadamosi also expressed concern about the burden placed on lone health workers, citing the case of the nurse at Agbinpa PHC, who attends deliveries, responds to emergencies outside working hours and sometimes buys basic consumables for patients.

“No PHC should depend entirely on the extraordinary commitment of one individual. Strong health systems are designed so that quality care does not rely on heroism,” he said.

He added that facilities enrolled under the Basic Health Care Provision Fund (BHCPF) are expected to receive quarterly funding to improve infrastructure, reduce medicine shortages and support additional health workers.

The expert also linked the findings to Nigeria’s high out-of-pocket healthcare spending, noting that transportation costs, referrals and the purchase of medicines and consumables impose additional financial burdens on households and often delay treatment.

Commenting on the Osun State Government’s strategy of prioritising selected “focal” PHCs, Mr Gbadamosi said concentrating resources on designated facilities may be necessary where funding is limited, but warned that surrounding communities should not be left without access to essential healthcare.

He said the success of any revitalisation programme should be measured not by the number of renovated facilities but by whether residents have better access to timely, affordable, high-quality healthcare.

 This reporting was supported by the Centre for Journalism Innovation and Development (CJID).

A new analysis by the World Health Organisation (WHO) has revealed that tobacco-leaf production in Africa increased by almost nine per cent between 2012 and 2024, despite a nearly 19 per cent decline in global production.

The increase, according to the findings, is raising concerns about the health risks faced by tobacco farmers and workers, as well as the wider environmental and social consequences of tobacco cultivation.

Africa produced more than 639,000 tonnes of tobacco leaf in 2024, representing about 11 per cent of global tobacco-leaf production, the analysis noted.

The findings showed that tobacco production is highly concentrated in five countries: Zimbabwe, Malawi, Tanzania, Mozambique and Uganda.

East Africa alone accounts for nearly 90 per cent of tobacco-leaf production on the continent.

Health risks

Vinayak Prasad, head of the Tobacco Free Initiative at WHO, said tobacco farming exposes workers and their families to serious health risks, while also damaging the environment and potentially trapping farmers in cycles of debt.

Mr Prasad said the issue extends beyond tobacco control and should also be viewed through the lens of health, trade, development and environmental sustainability.

“This is not just a tobacco-control issue. It is a health, trade, development and environmental issue,” he said.

The analysis identified green tobacco sickness as one of the direct health risks faced by tobacco farmers.

The condition occurs when nicotine from wet tobacco leaves is absorbed through the skin during handling.

Farmers and other workers may also be exposed to pesticides and tobacco dust during cultivation and processing, the report noted.

Beyond direct exposure, tobacco farming also consumes large amounts of land, water and other natural resources that could otherwise support food production and sustainable livelihoods.

The practice is also associated with soil degradation, deforestation and greenhouse gas emissions from the curing of tobacco leaves.

Children at risk

WHO also raised concerns about children from poor households being involved in tobacco farming.

According to the organisation, children in some low and middle-income countries miss school to work on tobacco farms and supplement their family income.

The report said this could further expose children to the health and social risks associated with tobacco cultivation while affecting their education.

Tobacco’s economic burden

The health concerns come alongside an increase in Africa’s cigarette imports.

According to the analysis, the continent’s cigarette import bill more than doubled between 2012 and 2024, rising from $833 million to $1.77 billion.

The findings also challenged the argument that tobacco is economically indispensable to most countries.

Tobacco-leaf exports account for more than one per cent of gross domestic product in only a small number of economies, including Malawi and Zimbabwe.

For most countries, the economic contribution of tobacco production and trade is limited, while the health, social and environmental costs remain substantial, WHO said.

Mr Prasad said countries needed support to move away from economic dependence on tobacco and provide alternative livelihoods for farmers and workers.

“Countries need support to move away from economic dependence on a product that harms health, farmers and the environment,” he said.

He said the findings showed why trade and development policies needed to be aligned with public health and sustainable development goals.

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Alternative livelihoods

Under Articles 17 and 18 of the WHO Framework Convention on Tobacco Control, countries are encouraged to promote economically viable alternatives for tobacco workers and growers.

The provisions also call on countries to protect the environment and human health from the effects of tobacco cultivation.

WHO called for stronger support for countries seeking to diversify away from tobacco production, protect farming communities and strengthen tobacco-control policies.

The organisation also urged countries to reduce the economic burden associated with tobacco use and trade.