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Early consideration of health and safety (H&S) in procurement is widely recognised as a way to improve construction performance. However, limited empirical research has examined how H&S can be integrated into emerging arrangements such as labour-only procurement systems (LoPS), particularly in developing countries. This study investigates barriers, opportunities, and strategies for embedding H&S in construction projects delivered through LoPS in Nigeria. A questionnaire survey was conducted with 76 construction professionals involved in ongoing or recently completed labour-only projects across public, private, and commercial sectors in both urban and rural areas. Data were analysed using descriptive statistics and Mann–Whitney U tests to identify barriers, perceived opportunities, workable strategies, and potential contextual differences. The results indicate key opportunities for improving H&S in LoPS, including clients’ cost-saving motivations and their close involvement in site activities. Effective strategies include using cost–benefit arguments to support H&S investment, encouraging early collaboration among clients, designers, and labour-only contractors, and incorporating H&S requirements into tendering and early planning. No statistically significant differences were found between urban and rural projects regarding the feasibility of these strategies. The study offers initial empirical evidence on feasible, context-specific approaches for strengthening H&S in LoPS across varied project settings.

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