From a fragile system with a shortage of professionals to significant progress in access to health care and disease control, the story of the World Health Organization (WHO) in São Tomé and Príncipe over the past 50 years is, above all, a story of fruitful partnership.
Sao Tome, 9 of june 2026 - When São Tomé and Príncipe accessed to its independence in 1975, the health sector faced enormous challenges. A shortage of human resource namely doctors and nurses, limited infrastructure, and a high burden of communicable diseases, which placed the country in a vulnerable position.
The first cooperation agreement between the country and the World Health Organization was signed on June 9, 1976, marking the beginning of a collaboration that will shape the national health system.
In his address during the celebration of the 50th anniversary of this cooperation, the WHO Representative Dr. Abdoulaye Diarra recalled that this moment marked the beginning of “a journey of work, partnership, and commitment to the health of the people of São Tomé and Príncipe”, a relationship that has grown alongside the country’s own development.
At the time, the situation was critical. “We inherited a country without trained professionals,” recalls physician Pascoal Vaz Fonseca, highlighting the scarcity of qualified personnel. Former WHO Representative (from 1991-1998) Dr João Ramos also described a system marked by “shortages of human resources, very few specialists and health structures.”
Training: the foundation of transformation
Faced with this reality, training health professionals became a priority. Over the decades, WHO supported the development of national capacity through scholarships, technical assistance, and professional training programs.
This investment proved decisive. “That support contributed immensely to the availability of trained staff” says Pascoal Vaz Fonseca. Today, the country has a significantly higher number of doctors and health workers, although challenges remain, particularly in specialized fields and how to maintain them within the country.
As highlighted by the WHO Representative, infant mortality has dropped drastically, from about 84 deaths per 1,000 live births in 1975 to around 9 today, while the life expectancy has increased from 55 to about 70 years.
Investment in human resources remains central. According to Sara Pereira, a WHO health systems specialist within WHO country office, the organization continues to support the strengthening of district health management capacities and promotes services that are “people-centered and accessible to all communities.”
Reorganizing and reforming the system
Beyond training, WHO played a key role in reorganizing the health system. From early on, it supported the Ministry of Health in defining policies, developing strategic plans (PNDS) and programmes, and improving infrastructure.
“The health system was still weak, and WHO played a very important role in strengthening it,” recalls former Minister of Health António Lima, referring to the support in combating diseases such as malaria, respiratory infections, and diarrheal diseases.
The introduction of the Expanded Programme on Immunization was one of the milestones of this transformation. Thanks to this cooperation, diseases such as measles and polio no longer represent a major public health threat in the country.
Public health outcomes
Five decades later, the results are visible. Diseases, before responsible for high mortality have been significantly reduced.
“Tuberculosis, malaria, and HIV/AIDS have seen a significant decline. Today, the country entered in a phase of malaria elimination and the elimination of vertical transmission of HIV” notes Jessica da Veiga, a WHO Disease Control and Health promotion specialist.
These achievements reflect not only the implementation of targeted programs but also the strengthening of a more structured and resilient health system.
For the government, this progress represents a strategic gain. In his speech, the Prime Minister, Américo Ramos, emphasized that cooperation with WHO represents “more than technical support,” but also “trust, solidarity, and a shared vision of human development centered on the dignity of the individual”.
The COVID-19 pandemic: The most critical moment of cooperation
The COVID-19 pandemic represented one of the country’s greatest recent challenges, and a test of the strength of its partnership with WHO.
When the first cases emerged, São Tomé and Príncipe was not fully prepared. “We were caught completely unprepared,” recalls former Minister Edgar Neves.
The response relied heavily on WHO support, from the procurement of protective equipment to the installation of a national diagnostic laboratory, considered as a key milestone in strengthening the country’s response capacity.
The Prime Minister, Américo Ramos, highlighted this period as one of the most critical moments of cooperation, pointing out the fight against COVID-19 as a clear example of WHO’s decisive role in supporting the country.
The role of partnership
Over these 50 years, one constant has been the importance of partnerships. WHO has acted as a facilitator, coordinating efforts between the government, UN agencies, and international partners.
According to Dr Evgeny Zheleznyakov WHO Health systems / UHC team lead, in WHO country office, this is one of the organization’s greatest strengths: “Through dialogue and partnership coordination, we are able to align priorities, mobilize resources, and support sustainable solutions for the health system.”
The Prime Minister reinforced this point, emphasizing the country’s commitment to building a health system that is “more equitable, more resilient, and capable of reaching all citizens,” highlighting the value of effective partnerships such as the one with WHO.
A legacy and a commitment
Today, São Tomé and Príncipe’s health system is far stronger than it was five decades ago. More professionals, improved infrastructure, and better health outcomes reflect years of sustained cooperation.
Still, challenges remain, including the need for specialized care, workforce retention, and the ability to respond to emerging health threats.
Yet the commitment endures. As stated by the WHO Representative, Dr Abdoulaye Diarra, the organization will continue to stand alongside the country “in promoting health for all and building a healthier future, leaving no one behind”.
For the government, this anniversary is also a moment to look ahead. “Celebrating 50 years is not only about remembering the past, but above all about renewing our ambition for the next 50 years,” said the Prime Minister, Americo Ramos, affirming the right of every citizen to “live with health, dignity, and hope”.
Five decades on, the story that began in 1976 is still being written, with the same guiding principle: health for all.
