São Tomé and Príncipe  recognizes that beyond health and well-being, investment in health also contributes to social inclusion, gender equality, poverty eradication, economic growth and human dignity. ​

Recent assessments have identified certain gaps and priorities for system reform in the health sector for it to become truly universal. These are: (i) the need to move from vertical to integrated programmes; (ii) the shift from a hospital-centred care delivery to a strong network of primary health care centres able to deliver health services, in particular prevention, adapted to the needs of people and closer to their homes; and (iii) reform of health financing that ensures vulnerable people have access to health care without facing financial hardship. These priorities have been incorporated into the new national health development plan 2023-2028.​

In addition, by increasing government investments in digital health technology, there is potential to extend health care services to marginalized areas  at reduced cost, and, as indicated by synergies, to enhance investments in energy, decent jobs, improved nutrition and in reducing inequalities.​

Progress on target 3.8 should be supported with policies to reduce energy intensity and to increase its access (Target 7.1) and efficiency to mitigate the negative impact on the share of renewable energy (Target 7.2) and on energy  efficiency (Target 7.3).​

Despite the relative progress in key social indicators, the country economy is not diversified and economic growth has not been inclusive. As a result, São Tomé’s young and fast-growing population lack employment opportunities – 50% of young women and 20% of young men (15 to 30 years old) are not employed,  (12% for women and 6% for men) – and rely on informal and subsistence activities.  Not surprisingly, a recent survey conducted among the youth in São Tomé revealed that a significant number (68%) are considering leaving the country in search of better opportunities elsewhere.​​

To address this challenge, the country needs a new development model based on private sector-led growth which focuses on improving human capital, infrastructure and the business environment to unleash the potential for the blue economy, high- value nature-based tourism and high-quality, niche agricultural production. ​

By implementing policies that build human and physical capital and generate economic opportunities (SDG 8 - decent work and economic growth), STP can address the current employment challenges to focus on key priority areas, such as poverty eradication, zero hunger, improved health care and education.​

Progress on target 8.5 should be supported with policies to reduce energy intensity and increase its access (Target 7.1) and efficiency  to mitigate the negative impact on the share of renewable energy (Target 7.2) and on energy  efficiency (Target 7.3).​

Extreme poverty remains high for São Tomé and Príncipe’s GDP per capita level of US$2400, with about 15.4% of the population living on less than US$2.15 per day (in 2017 PPP terms), 44.6% on less than US$3.65 per day (the poverty line for LMIC) and income inequality (Gini index of 40.7). STP’s income inequality has increased between 2010 and 2017, particularly in urban areas. This partly explains the small gains in poverty reduction despite an increase in GDP per capita.​

To reduce poverty and inequality, STP should prioritize inclusive and  sustainable growth, which strengthens resilience, builds relevant skills,  creates jobs and protects natural resources. It is also important to expand social protection schemes currently benefiting just 5,000 families. By implementing policies that build human and physical capital and generate economic opportunities, STP has the potential to address inequality and yield multiple benefits for other SDGs, including poverty, hunger, education, gender and health outcomes, among others.​

These interventions, if sustainably designed, would both protect the environment and enhance the Government’s responsiveness. ​

In São Tomé, approximately 68.1% of the population are satisfied with public service delivery. By focusing on SDG 16 (Peace, justice and strong institutions), and specifically on Target 16.6, measures can be implemented that cut across all goals and pillars outlined in the National Development Plan 2020-2024, where public services are provided. ​

São Tomé’s challenges lie in addressing inequality, poverty and unemployment. Improving living standards necessitates a multifaceted approach that includes increasing employment opportunities, boosting incomes through diversification of the economy, productivity growth, the provision of a social safety net, and fostering a strong connection between capabilities, opportunities and employment for improved social and living conditions. ​

Crucially, effective leadership, an engaged citizenry and effective government play vital roles in driving development within a socially cohesive environment. ​