Integrating sustainable medical practices in low-resource settings remains a significant challenge. Angola's complex healthcare landscape offers a pertinent case for examining the long-term adoption and impact of such approaches within obstetrics and gynaecology. This longitudinal study aimed to analyse the implementation and outcomes of sustainable medical practices within Angola's maternal health sector. Its primary objectives were to assess changes in practice adoption over time, identify key enabling and constraining factors, and evaluate associated trends in maternal health indicators. A mixed-methods longitudinal design was employed. Quantitative data were collected from a representative sample of public health facilities at regular intervals. Qualitative data were gathered via serial, in-depth interviews with healthcare providers, policymakers, and service users to capture evolving perspectives and contextual dynamics. Analysis indicated a positive trajectory in the adoption of several sustainable practices, notably task-shifting and the use of reusable medical equipment. A central theme was the critical role of continuous, localised training. By the final assessment, a substantial proportion of facilities had integrated core sustainable protocols into standard operating procedures, although significant regional disparities persisted. Sustainable medical practices can be progressively integrated into Angola's obstetric and gynaecological services, contributing to system resilience. Success is contingent on sustained investment in human resources and context-specific adaptations, rather than short-term technological solutions. Policy should prioritise decentralised training programmes and sustainable supply chains. Future initiatives must address regional inequities and incorporate robust monitoring frameworks to assess long-term efficacy and cost-effectiveness. Sustainable healthcare, maternal health, longitudinal study, medical practices, Angola, obstetrics, gynaecology This study provides a long-term evidence base on the implementation of sustainable medicine in a Southern African context, offering practical insights for policymakers and practitioners aiming to strengthen health system resilience.
Quissanga et al. (Wed,) studied this question.