Navigating Sustainable Healthcare: A Qualitative Study of Obstetric and Gynaecological Services in São Tomé and Príncipe

Sustainable healthcare delivery in low-resource settings is a critical challenge. As a small island developing state in Africa, São Tomé and Príncipe faces distinct obstacles in providing consistent, quality obstetric and gynaecological care, which affects maternal and women’s health outcomes. This study explored the key barriers and enablers to sustainable obstetric and gynaecological service delivery in São Tomé and Príncipe from the perspectives of healthcare providers and health system stakeholders. A qualitative, exploratory study was conducted using semi-structured interviews. A purposive sample of 24 participants was recruited, including midwives, doctors, nurses, and health ministry officials. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Analysis identified three primary themes: infrastructural and resource scarcity, workforce capacity and retention, and community engagement. A prominent finding was the recurrent shortage of essential commodities, such as suture materials and uterotonics, reported by nearly all clinical participants. This led to frequent service interruptions and ad-hoc adaptations in clinical practice. The sustainability of obstetric and gynaecological services in São Tomé and Príncipe is undermined by interconnected systemic weaknesses, particularly chronic supply chain failures and human resource challenges. These issues compromise the consistency and quality of care. Priorities include strengthening the medical supply chain and logistics management, developing targeted retention strategies for skilled staff, and fostering deeper community-based health partnerships to improve service utilisation and resilience. Sustainable healthcare, qualitative research, obstetric services, gynaecology, São Tomé and Príncipe, health systems, maternal health This study provides context-specific evidence from an under-researched African island nation, offering practical insights for policymakers and health planners aiming to enhance service sustainability.