Young people in Africa should have a say in decisions that affect their health – 7 ways to include them

Most of Africa’s population – 70% – is under 30 years old. In 2017 there were 628 million young people under 25 on the continent. This figure is predicted to reach 945 million by 2050.

Young people bear the brunt of many challenges facing African countries. African adolescent girls and young women have the highest HIV infection rates. The continent has the highest rate of teenage pregnancies in the world. Many young people in Africa live with conflict and violence and are displaced. Many lack food, education and jobs.

Yet young people are not heard in decisions that directly affect their lives and health. The United Nations Youth envoy stresses the importance of giving young people opportunities to be involved in decision-making. Leaders around the world pledge to work with young people, but they don’t know how.

In our recent research we set out ways to work with young people in healthcare. Our recommendations are based on an overview of 30 published studies of working with young people in a number of countries, including South Africa and Tanzania.

Our study provides seven ways that leaders and organisations in healthcare can ensure that young people’s time and opinions are valued within their programmes. This includes long-term engagement and frequent contact as well as valuing young people’s changing school, work and social lives.

Seven ways to work with young people

Include young people from the beginning and throughout the decision-making process. Young people need to guide programmes on what is important to them. They should be invited at the beginning of any new programme to ensure that it is based on young people’s agendas and priorities. This should also be monitored throughout the programme and adapted to young people’s evolving opinions and to world events.

Make a long-term commitment and make frequent contact with young people to build trust, respect and leadership. Youth-led committees and councils ensure that young people are leading the decision-making. Committing to at least a year shows the young people that their opinions are valued. Frequent contact builds young people’s trust in the programme. Having in-person meetings also helps to build trust, especially in the early stages of the programme.

Use digital tools. Take advantage of social media to find young people to work with and keep them engaged between meetings. Ask young people what social media they are using, such as Instagram, BeReal and TikTok. Using creative digital tools such as games, avatars and videos as part of your programme can also keep young people interested. Digital tools also support young people with disabilities, who live in remote areas or are without transport to attend in-person meetings. Issues such as internet connection and unreliable electricity would need to be worked out together with the young people.

Build in training opportunities for young people to improve their leadership and advocacy skills. The teenage years are important for learning new skills and for young people to learn what they want to do with their lives. Young people see skills training opportunities as an incentive to take part. These can also help them apply for jobs or further education. Training helps young people to feel more confident to make decisions and work in the team.

Plan to manage power dynamics between adults and young people. This may include strategies on communication, neutral spaces for young people to discuss and work away from adults, ways to report any issues, and who makes the final decisions.

Involve community leaders, parents, friends and siblings to build trust. Young people like to work with people similar in age to them. They may also want to discuss opinions with their parents. Inviting community leaders to meetings further shows that you value young people’s opinions as they have the opportunity to tell the leaders what they want.

Value their time and respect their changing school, work and social lives. Try to understand what is going on in their lives. Often young people are writing exams or starting new schools or universities or want to spend more time with friends or new partners. For long-term commitment, programmes should give a suitable payment to show that you value their time and investment in the programme. We encourage you to provide young people with references for jobs and education.

The way forward

Leaders and organisations across Africa need to seriously rethink how they work with young people. Is it a meaningful, respectful and productive use of young people’s time or just a tick-box exercise?

At the end of January 2023 the World Health Organization (WHO) hosted the first ever Youth Council. Dr Tedros Ghebreyesus, the WHO director-general, pledged:

We will listen to you [young people] carefully because I know you will bring fresh perspectives because this is your generation, your time. You understand things very differently to how we understand things and that’s why we need to take your ideas very very seriously.

It is encouraging to see the WHO leading by example. We hope this will trickle down to leaders across Africa.