Building an effective healthcare system, São Tomé and Príncipe


Institutional capacity issues such as the the shortage of qualified human resources in the national healthcare system and its inability to provide specialized health care services, are just some of the challenges faced by the Democratic Republic of São Tomé and Príncipe.

With funding from IPAD and the Calouste Gulbenkian Foundation, Instituto Marquês de Valle Flôr (IMVF) has been working with the Government of São Tomé and Príncipe for the past two decades to develop the capacity of the national healthcare system. Supported by the ‘Health for All Programme’ the system has transformed into a decentralized and efficient network of local health units. Now covering the entire country, the healthcare system promotes prevention services and offers both primary and specialized healthcare.

Development results

Started with a pilot in one district in 1988, the initiative covered, in 2008, all the seven districts in the country. After 20 years of implementation, the initiative has led to remarkable results.

An IMVF’s evaluation from 2010 shows that maternal and child healthcare coverage is close to 100 percent. Some 98 percent of women visited a health facility at least once, with 72 percent making four or more visits. The number of medical consultations also rose dramatically – from just over 61,000 in 2008 to more than 136,000 in 2010. Control of malaria shows highly encouraging results, with the incidence falling from 22,7 percent in 2005 to 2,2 percent in 2009 (90% decline). World Bank figures also show that the country’s life expectancy rose from 61 years in 1990 to 64 years in 2009.

The country is likely to achieve the health-related Millennium Development Goals by 2015.

Enhanced performance

These results are premised on a series of capacity development interventions, including: the professional training of health technicians and administrative staff; the introduction of an integrated package of preventive, primary, and specialized health care; the sensitization of the general population through an education campaign and the introduction of telemedicine.

A network of two hospitals, six health centres, 28 health posts, and 17 community health units has been strengthened through significant investments in the technical capacities of health workers. The professional qualifications of health technicians and administrative staff at central and district levels have been enhanced by theoretical and practical training initiatives, held in São Tomé and Príncipe and in Portugal. Investment in developing professional management and planning capacities has brought significant improvements in the quality and delivery of services.

All health units are now providing a decentralized integrated package of preventive, primary and specialized health care services, including family planning, maternal and child care and others. Demand for such services is stimulated by education campaigns conducted at the community level. Health Delegates monitor the implementation of the package through inspection and the application of monitoring tools. The accuracy of data collected at district level and reported to the Ministry of Health has also been enhanced. A coordination unit, which acts in the capacity of a Central Pharmacy, takes orders from and provides stocks to health centres, applying fixed cost recovery prices. A Ministry regulation (Despacho nº 10/GMS/2009) has determined a financial penalty for physicians, nurses, district officers and technicians who do not comply with the guidance provided by the Health District coordination unit.

Emerging medical needs made clear the necessity of an approach that allows swifter and more suitable solutions for more complex care provision, the decrease in the number of evacuated patients to Portugal and the promotion of local competences. In 2011 the project launched the Telemedicine: health information and communication technology bring together São Tomé and Príncipe’s Central Hospital and Portuguese medical experts of all specialties. Telemedicine breaks the isolation to which the country and the medical practice have been confined to, and incorporates them in a network of experienced professionals and state of the art techniques and technology. Portuguese doctors can now provide long distance training and direct support to São Tomean doctors for the management of medical cases. Telemedicine represents a strategic and an innovative institutional arrangement for the delivery of health services.

The system has also been provided with adequate equipment, medicines, analysis laboratory, and an improved infrastructure.

Support to the capacity development process

National investments

Leadership and the big push for change have come from the Ministry of Health and Social Services and the district health centres.

The Ministry of Health and Social Services has retained the major responsibility for managing and implementing the programme’s activities, facilitating communications between local and central actors, upgrading procedures and monitoring progress. The Ministry has invested in its district management through training, structured tools, inspection, and information routines and equipment to upgrade the Health Delegates capacities.

Development partners’ support

Management consultants from IMVF worked with the Ministry of Health and Social Services to provide technical assistance to health units’ management. They also arranged staff and health agents’ training programmes, mostly using the public health system’s own capacity.

The Portuguese High Commissioner for Health has recognized the intervention’s
“public interest”. That allows experts from the Portuguese Ministry of Health to provide assistance to São Tomé and Príncipe free of charge.

IMVF played a supporting role in the project’s design, in establishing bridges with local partners, and in coordinating between health specialists and representatives of the governments of São Tomé and Príncipe and Portugal.

Find out more

Please contact Dr. Ahmed Zaky
Project Director at IMVF
Phone: + 351 96 622 84 49

Year of publication: 
LenCD "Capacity: Results"
Themes and sectors: 
Health sector

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