Health in São Tomé and Príncipe

The public health network includes Centros de Saúde (CS), meaning health centres, and Postos de Saúde (PS), meaning smaller health posts, across Água-Grande, Mé-Zóchi, Lembá, Lobata, Caué, Cantagalo and Príncipe. These facilities provide the main access point for primary care, prevention, vaccination, maternal and child health, family planning, sexual and reproductive health services, health education and community outreach. Traditional medicine also exists locally, but its formal integration into the public system remains a planning objective rather than an established nationwide pathway. Hospital Ayres de Menezes in São Tomé is the national reference hospital. Hospital Regional Manuel Dias da Graça serves Príncipe. The intended pathway is PS or CS first, followed by referral to the appropriate hospital and later return to primary care for follow-up. The referral and counter-referral network is still being developed, and Príncipe remains more vulnerable to geographic and infrastructure constraints. Specialist treatment that is unavailable locally may require evacuation to Portugal; cancer is a frequent reason for such evacuations, with 53 patients evacuated for tumours in 2020. The national vaccination programme has operated since 1977. A universal hepatitis B dose at birth has been provided since 2016. Vaccinations are available through health centres, maternal and child health services, campaigns, mobile teams and community health workers. Reported coverage was 87% in 2023; UNICEF indicators reported 97% DTP3 coverage in 2022 and 77% first-dose measles coverage in 2022. São Tomé and Príncipe has eliminated neonatal tetanus and remains polio-free, although coverage can differ between vaccines and locations. Pregnant women can receive care through clinics, and maternal services include family planning and contraceptive care. HIV-positive women can receive integrated maternal, reproductive and HIV services. Adolescent access to sexual and reproductive health services can depend on age and the specific service, with some access available without parental consent. Skilled birth attendance was 97% in 2019. The maternal mortality ratio was estimated at 146 deaths per 100,000 live births in 2020, while under-five mortality was 15 per 1,000 live births and neonatal mortality was 8 per 1,000 in 2021. The reference hospital provides paediatric and neonatal care, and newborns receive a medical examination before discharge. The Ministry of Health lists 112, 113 and 115 for urgent and emergency assistance. Emergency treatment and inpatient admission are free of charge. A reliable nationwide pre-hospital emergency transport system is not yet established; regulation and service reactivation have been identified as needs, and emergency management on Príncipe remains a critical gap. There are no reliable national figures for waiting times or opening hours, so the local facility should confirm availability before a planned visit when the situation permits. São Tomé and Príncipe has no national health insurance system. Free access is limited mainly to emergencies and inpatient care, pregnant women, children under five and externally funded malaria, HIV and tuberculosis programmes. Routine consultations, medicines, tests and referrals can therefore involve direct household payments. Catastrophic health spending affected 10.2% of households in the available assessment, and costs can delay routine care or contribute to overcrowding in emergency departments. The Fundo Nacional de Medicamentos (FNM), the National Medicines Fund, supplies institutions and patients, but the country depends heavily on imported medicines and medical technology. Procurement and stock interruptions can affect availability. São Tomé and Príncipe has no separate national medicines regulatory authority, national quality-control laboratory or national price-regulation system according to the available health-system assessment. Counterfeit-medicine risk is therefore relevant, and the cheapest generic medicines were estimated at about 4.9 times the international reference price. Health centres provide minimum diagnostic services such as a blood count, urine testing, electrocardiography and X-rays. Hospital Ayres de Menezes adds biochemistry, microbiology, cytology, ultrasound, echocardiography and computed tomography. National pathology, histology and cytopathology capacity is still an expansion objective, which helps explain why some cancer diagnoses and treatments require referral abroad. Non-communicable diseases are now the leading cause of death, and about 70% of Hospital Ayres de Menezes admissions were related to them in 2020. Hypertension affected an estimated 30.6% of adults. Tuberculosis incidence was estimated at 36.8 cases per 100,000 people in 2021. People who test positive for HIV receive antiretroviral therapy immediately through the programme, while hepatitis C treatment was not nationally available in the available assessment. Water-related and neglected tropical diseases remain relevant public-health concerns. Psychiatric and psychological services exist at Hospital Ayres de Menezes. The hospital recorded 946 outpatient psychiatric consultations and 334 psychiatric admissions in 2020, but reliable nationwide prevalence data and evidence of integrated community mental-health care remain limited. Follow-up after treatment is intended to continue through CS and PS services. HIV-exposed infants receive follow-up at primary treatment clinics, and specialised neonatal or paediatric cases return to the reference hospital when necessary. Continuous and palliative care networks are still being developed nationwide. Telemedicine and a unified electronic medical record remain pilot or expansion objectives, while DHIS2 reporting currently focuses mainly on vaccination, reproductive health, tuberculosis, HIV/AIDS and malaria. The PNDS 2023–2032 health plan provides a planning and baseline framework, but individual projects should not be treated as fully implemented without confirmation. The plan includes a patient rights and duties charter and a complaints mechanism, yet reliable nationwide implementation has not been established. Information about causes of death also requires caution because death registration is incomplete and unreliable. Current facility contacts and service availability should be checked through the Ministério da Saúde, especially for referrals, medicines, emergency transport and services on Príncipe.