Despite billions of naira allocated to healthcare and hundreds of millions of naira committed to primary healthcare projects, residents in parts of Osun State continue to face deteriorating facilities, inadequate staffing and limited access to basic medical services.
An investigation across three primary healthcare centres in Agbinpa, Abudo and Ekusa found that conditions at some rural facilities remain at odds with the state government’s claims of sustained investment in grassroots healthcare.
At Agbinpa Primary Healthcare Centre in Ede South Local Government Area, overgrown grass covers parts of the compound, while peeling paint, deep cracks and deteriorating sections of the building point to years of inadequate maintenance.
The journey to the facility from Osogbo takes about an hour by commercial motorcycle, largely because of the poor condition of the rural roads.
Inside the facility, Rashidat Lamidi, the only health worker serving the community during the visit, attends to pregnant women, children and other patients while also handling administrative duties.
Mrs Lamidi said she regularly responds to emergency calls outside working hours and sometimes purchases basic consumables when they are unavailable.
“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.
Although she said the state government pays her salary regularly, she expressed concern about the lack of attention given to the facility despite repeated visits by politicians and government officials, particularly during election periods.
“They come here, but they don’t do anything.”
Rural Residents Pay More For Basic Care
The condition of Agbinpa PHC has not reduced its importance to residents, but it has made accessing healthcare more difficult and expensive.
The facility has no functional laboratory, forcing patients who require basic blood tests to travel about 26 kilometres to Ede.
Delivery equipment available at the centre was also inadequate for the number of patients it serves. Women in labour are sometimes required to purchase gloves, methylated spirit and other consumables before receiving care.
Iya Beji, who delivered all five of her children at the facility, praised Mrs Lamidi but said the poor condition of the centre discourages residents from using it.
“The nurse is good. It is only because of the condition of the hospital that people do not come here,” she said.
Patients requiring scans are referred to Ede, where transport alone can cost about N6,000.
“If someone is sick, what can we do? We have to go.”
Transportation is itself another burden.
Abdulrahaman Babatunde, a resident, said commercial motorcycles rarely use the road leading to the community 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.”
The poor road also affects farmers trying to transport produce to nearby markets, while the community has struggled with unreliable electricity.
Residents said private solar charging operators charge between N400 and N700 to charge 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.”
Mrs Lamidi is also worried about what will happen to the facility when she retires.
“I don’t know what will happen to this place,” she said.
Abudo PHC Faces Access And Staffing Problems
At Abudo Primary Healthcare Centre in Egbedore LGA, the challenge begins before patients get to the facility.
The road is in such poor condition that commercial motorcyclists reportedly avoid the community. When the facility was visited at about 1 p.m., it was locked.
Patient registers and other documents could be seen through dusty louvre windows, while cobwebs covered parts of the building.
No health worker was present. Telephone numbers had been written on a wall for patients who needed assistance, but repeated calls to the numbers either failed to connect or went unanswered.
Chief Alao, a community leader, said the facility serves Abudo and several neighbouring settlements, but years of poor road infrastructure have isolated the area.
“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 patients requiring services unavailable at Abudo are referred to Ede, about 16 kilometres away.
She said residents also depend on a motorcycle vendor who brings orthodox medicines into the community because Abudo has no pharmacy.
Without the vendor, she said, residents would have to travel outside the community to purchase essential medicines.
Another resident, Kehinde Olumide, said transportation remains a major problem.
“We hardly see motorcycles here,” he said. “And when you get one, it is very expensive because of the road.”
2020 Renovation, Familiar Problems At Ekusa
At Ekusa in Odo-Otin LGA, the community’s PHC was renovated in 2020, according to an inscription on the building.
The project was carried out by the Odo-Otin Local Government and commissioned on 15 March 2020.
Six years later, however, residents said many of the problems affecting healthcare delivery remain unresolved.
During the visit, parts of the premises were overgrown with weeds and the facility’s borehole was not functioning.
Health workers declined to discuss the condition of the facility, with one requesting anonymity and saying staff had been directed to refer enquiries about PHCs to the Osun State Primary Health Care Development Agency.
“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.”
Residents said the facility typically closes around 4 p.m., meaning patients arriving later must either wait until the following day or seek care elsewhere.
A resident identified as Mojisola said patients frequently leave the community whenever the facility cannot provide the treatment they require.
Abdulrahaman Wasiu, a spiritual and youth leader, said little had changed since the 2020 renovation.
“People only came to paint the building,” he said. “Apart from that, nothing much changed.”
Mr Wasiu said he once visited the facility after suffering a dislocation but left without receiving the treatment he needed.
He also described the facility as chronically understaffed.
A man who identified himself as a supporter of Governor Ademola Adeleke and accompanied the reporter to the facility acknowledged that it needed attention. He also confirmed that health workers had been instructed to direct enquiries to the state primary healthcare agency.
He said Governor Adeleke would intervene if he became aware of the facility’s condition.
N157.74bn Budgeted For Health Since 2020
The conditions observed at the three facilities contrast with the scale of the Osun State Government’s budgetary commitments to healthcare.
An analysis of approved state budget documents shows that Osun allocated about N157.74 billion to the health sector between 2020 and 2026.
The state budgeted N7.2 billion for health in 2020, representing 6.02 percent of its N119.55 billion total budget.
The allocation increased to N9.8 billion in 2021 and N12.4 billion in 2022, representing 8.93 percent and 9.56 percent of the respective state budgets.
Health spending accounted for its highest share of the state budget during the period in 2023, when N17.92 billion, or 12.96 percent of the N138.27 billion budget, was allocated to the sector.
Although the percentage subsequently declined, nominal allocations continued to rise.
The state budgeted N18.6 billion for healthcare in 2024, N32.58 billion in 2025 and N59.24 billion in the approved 2026 budget.
Budget implementation data also indicates increased spending.
BudgIT’s State of States reports show that Osun’s capital expenditure increased from N18.7 billion in 2020 to N118.4 billion in 2024, while actual health expenditure rose from N10.6 billion to N17.7 billion over the same period.
The Ministry of Health and Human Services also recorded improved performance ratings.
The figures suggest growing public investment in healthcare, but conditions observed at the three rural PHCs raise questions about how effectively such investments are translating into services at community level.
Millions Awarded For PHC Projects
Procurement records reviewed as part of the investigation show that the state Ministry of Health awarded numerous contracts between 2020 and 2024 for healthcare infrastructure, medical equipment, solar power systems, boreholes and other projects.
In 2020, the ministry awarded Olupopson Nigeria Limited a N35.7 million contract for the rehabilitation and upgrading of General Hospital, Ifetedo.
It also approved N6.8 million for the procurement of 4,000 cartons of noodles. Both projects were listed as completed on the state’s procurement portal.
Subsequent contracts covered equipment including theatre lamps, diathermy machines, X-ray machines, instrument trolleys, suction machines, emergency stretchers, ultrasound scanners, ECG machines, hepatitis B testing kits, HIV/AIDS consumables, laboratory supplies, computers and surgical equipment.
Most of the contracts reviewed were marked completed, although some remained active or had no stated completion status.
The largest investments reviewed were recorded in 2024.
The state awarded multiple contracts valued between N426 million and N592 million for PHC renovations across the three senatorial districts.
Separate contracts worth more than N188 million each were awarded for solar power and inverter systems across the districts.
Additional contracts ranging from N119 million to N556 million were approved for the sinking and repair of boreholes.
Many of the 2024 projects were still listed as “Active” on the procurement portal when the records were reviewed.
However, the procurement documents did not identify the individual PHCs covered under the various project phases.
As a result, it could not be independently established whether Agbinpa, Abudo or Ekusa PHCs were among the facilities selected for renovation, solar installation or borehole projects.
Adeleke Government Says PHC Investment Is Ongoing
The Osun State Government has repeatedly described primary healthcare as a priority of the administration.
During an inspection of renovated PHCs in Telemu, Ola-Oluwa LGA, and Ido-Osun, Egbedore LGA, in March 2025, Governor Ademola Adeleke said his administration was committed to improving access to healthcare, particularly in rural communities.
According to the governor, the state’s rehabilitation and upgrading programme was designed to strengthen healthcare delivery at the grassroots.
“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 said the government was prioritising primary healthcare before extending interventions to secondary and tertiary facilities, arguing that stronger PHCs would improve early detection and treatment.
In a November 2025 anniversary broadcast, the governor said his administration had rehabilitated more than 200 PHCs across the state.
He said the work included structural rehabilitation, clean water systems, perimeter fencing, roofing, furniture, sanitation facilities and solar power.
According to him, another phase covering nearly 200 additional facilities was already underway.
The governor also cited 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 linked to progress on universal health coverage indicators.
But the findings from Agbinpa, Abudo and Ekusa suggest that the impact of those investments remains uneven.
Agency Blames Funding Constraints
Responding to the findings, the Executive Secretary of the Osun State Primary Health Care Development Agency, Adesina Igbalaye, said the government had made significant investments in primary healthcare.
Mr Igbalaye said the agency conducts monthly and quarterly assessments of PHCs, examining infrastructure, staffing, equipment and service delivery.
He said the assessments are used to identify facilities requiring intervention.
According to him, the state adopted a strategy of upgrading one focal PHC in each ward.
The selected facilities receive renovations, solar power systems, boreholes, medical equipment and other interventions, he said.
Mr Igbalaye also said the government had introduced stipends for volunteer health workers who previously worked without pay and provided counterpart funding for health programmes implemented with development partners.
On concerns that the facilities visited lacked basic services, he said the revitalisation programme was designed to prioritise one focal facility per ward while other centres continued providing routine services.
He attributed delays in extending improvements to more facilities to funding constraints.
According to him, disputes over local government administration affected access to local government funds from February last year, slowing implementation of parts of the programme.
He said work had nevertheless continued in some facilities through other government interventions, including drug supplies and routine support.
Mr Igbalaye maintained that the agency’s assessments had helped identify infrastructure and service gaps and that the government remained committed to improving primary healthcare access.
Government Assessment Confirms Persistent Gaps
A second-quarter 2026 report supplied by the agency provides further evidence of some of the challenges identified during the field visits.
The agency’s Directorate of Planning, Research and Statistics conducted a five-day routine quarterly quantitative integrated supportive supervision exercise between 1 and 5 June 2026.
The exercise covered at least 150 PHCs across 15 selected LGAs and assessed 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 or provide a facility-by-facility breakdown, making it impossible to determine whether Agbinpa, Abudo and Ekusa were among the facilities assessed.
It nevertheless documented problems similar to those found during the investigation, including shortages of health workers, stock-outs of essential medicines and consumables, absenteeism, poor record-keeping and difficult road conditions.
The report said 50 facilities experienced stock-outs of malaria medicines, while 20 lacked oral rehydration salts, which are used to manage diarrhoea.
It also noted that poor road conditions during the rainy season affected access to some rural PHCs and that human-resource shortages remained a system-wide challenge.
The agency recommended the procurement of essential medicines and consumables, conversion of ad hoc and volunteer workers to permanent staff, stronger monitoring of attendance and increased funding for supervision.
‘Buildings Alone Do Not Make PHCs Functional’
Sheriff Gbadamosi, Advocacy and Community Engagement Manager at Nigeria Health Watch, said the findings reflect broader weaknesses in Nigeria’s primary healthcare system.
He said PHCs are intended to serve as the first point of contact with the health system, meaning residents travelling long distances for basic services raises questions about whether public investments are achieving their intended purpose.
“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.”
Mr Gbadamosi said renovation was important but could not, by itself, improve health outcomes.
He identified workforce shortages, weak supply chains, financing gaps and governance problems as wider challenges affecting Nigeria’s PHC system.
He also raised concerns about the burden placed on individual health workers, citing the Agbinpa nurse who attends deliveries, responds to emergencies outside working hours and sometimes purchases 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 noted that facilities enrolled under the Basic Health Care Provision Fund are expected to receive quarterly funding to improve infrastructure, address medicine shortages and support additional health workers.
Mr Gbadamosi also linked the challenges to Nigeria’s high out-of-pocket healthcare spending, saying transportation, referrals and the cost of medicines and consumables add to the financial burden on households and can delay treatment.
On Osun’s strategy of prioritising selected focal PHCs, he said concentrating resources 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 PHC revitalisation programme should ultimately be judged not by the number of buildings renovated but by whether residents have better access to timely, affordable and quality healthcare.
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