Sao Tomé & Príncipe
GaneshAID supported Sao Tomé & Príncipe in zero-dose child identification and Gavi application development — a small island state where geographic isolation creates unique barriers to equitable immunisation coverage.
Key Immunisation and Health System Challenges
As a small island nation in the Gulf of Guinea, Sao Tomé & Príncipe faces distinctive immunisation equity challenges. Geographic fragmentation across two main islands and multiple islets limits outreach capacity, while small population size can mask significant pockets of zero-dose and under-immunised children in remote communities.
GaneshAID's technical assistance supported the Ministry of Health in systematically identifying where coverage gaps exist, understanding the underlying causes, and designing targeted programmatic interventions for Gavi funding. The HCD approach ensured solutions were grounded in local realities and community acceptance.
Island geography creates logistical barriers — cold chain continuity, transport to remote communities and maintaining supervision quality — that require specifically designed outreach strategies to ensure no child is left behind.
GaneshAID Support in Sao Tomé & Príncipe
Zero-dose child identification and barrier analysis
Primary and secondary analysis responding to all key analytical questions from Gavi's Zero-Dose Analysis Cards ("identify" section). Additional qualitative data collection conducted where the country context required it. Analysis covered geographic coverage gaps, demand-side barriers, supply-side constraints and systemic factors — differentiated by community typology (conflict zones, rural, urban informal, mobile populations).
HCD ideation sessions for tailored solutions
Interactive ideation sessions facilitated in-person and/or remotely using Human Centred Design methodology. Sessions brought together Ministry of Health staff, EPI teams, NGOs, local CSOs and humanitarian actors to co-design new, tailored and sustainable solutions directly addressing identified barriers to reaching zero-dose children. Documentation of minutes, action items and follow-up assurance throughout.
Gavi funding application development
Development of a complete set of prioritised, sustainable programmatic interventions reflected in: (1) Theory of Change for Gavi investments; (2) the supporting country application narrative; and (3) the submitted work plan, budget and Monitoring & Learning Plan. All applications developed under Ministry of Health leadership with full EPI stakeholder engagement.
Operational Contributions and System Improvements
As part of an eight-country zero-dose programme, applications were developed successfully under the leadership of the Ministry of Health, with full engagement of EPI stakeholders including NGOs, local CSOs and humanitarian actors. The participatory approach built national analytical capacity beyond the immediate application cycle.
Ministry-led applications
All applications developed under Ministry of Health ownership — national propositions, not donor-driven products.
Differentiated barrier analysis
Zero-dose typologies and barriers identified by context: conflict zones, rural areas, urban settlements and mobile populations.
HCD-validated solutions
Tailored programmatic interventions co-designed with national stakeholders and validated through participatory ideation.
Partners and Ecosystem in Sao Tomé & Príncipe
Part of an eight-country zero-dose programme
This engagement is one of eight countries where GaneshAID provided participatory technical assistance for Gavi funding applications. The multi-country programme covered EAF, HSS, CCEOP and FPP funding streams, building a replicable model for equity-focused zero-dose programme design across fragile and low-resource contexts.