Between Rhetoric and Reality: Learnings From Youth Participation in the Adolescent and Youth Health Policy in South Africa

Abstract

Background: Youth participation makes an essential contribution to the design of policies and with the appropriate structures, and processes, meaningful engagement leads to healthier, more just, and equal societies. There is a substantial gap between rhetoric and reality in terms of youth participation and there is scant research about this gap, both globally and in South Africa. In this paper we examine youth participation in the Adolescent and Youth Health Policy (AYHP) formulation process to further understand how youth can be included in health policy-making. Methods: A conceptual framework adapted from the literature encompassing Place, Purpose, People, Process and Partnerships guided the case study analysis of the AYHP. Qualitative data was collected via 30 in-depth, semi-structured interviews of policy actors from 2019-2021. Results: Youth participation in the AYHP was a ‘first’ and unique component for health policy in South Africa. It took place in a fragmented policy landscape with multiple actors, where past and present social and structural determinants, as well as contemporary bureaucratic and donor politics, still shape both the health and participation of young people. Youth participation was enabled by leadership from certain government actors and involvement of key academics with a foundation in long standing youth research participatory programs. However, challenges related to when, how and which youth were involved remained. Youth participation was not consistent throughout the health policy formulation process. This is related to broader contextual challenges including the lack of a representative and active youth citizenry, siloed health programs and policy processes, segmented donor priorities, and the lack of institutional capability for multi-sectoral engagement required for youth health. Conclusion: Youth participation in the AYHP was a step toward including youth in the development of health policy but more needs to be done to bridge the gap between rhetoric and reality.

Politics–evidence conflict in national health policy making in Africa: a scoping review

“…It emerged also that donor financing facilitated the process of national public health policy, but strategically skewed the power balance and goals of some health policies [ 24 , 40 , 41 ]. In some cases, donor powers were used in the positive direction, but negatively in others [ 29 , 41 – 44 ].…”

“…It emerged also that donor financing facilitated the process of national public health policy, but strategically skewed the power balance and goals of some health policies [ 24 , 40 , 41 ]. In some cases, donor powers were used in the positive direction, but negatively in others [ 29 , 41 – 44 ]. Moreover, power imbalances associated with funding sometimes disrupt the flow of funds from donors, something which negatively affects the content and original purpose of national public health policies in Africa [ 41 , 42 , 45 ].…”

“…In some cases, donor powers were used in the positive direction, but negatively in others [ 29 , 41 – 44 ]. Moreover, power imbalances associated with funding sometimes disrupt the flow of funds from donors, something which negatively affects the content and original purpose of national public health policies in Africa [ 41 , 42 , 45 ].…”

“…We found that fragmented stakeholder interest, institutional responsibility and accountability, inadequate understanding and interpretation of context by stakeholders divided perspectives of actors on the policy context, and lack of understanding among actors about how policy should be financed limits national public health policy formulation [ 27 , 30 , 41 , 51 – 53 ]. Moreover, incomplete and inaccurate data, poor management of resources, improper coordination and communication between actors, inadequate consultation with relevant stakeholders and inconsistency among actors during policy dialogue and formulation processes are also critical limitations to policy formulation [ 26 , 40 , 41 , 52 – 55 ].…”

“…We also noticed delays in the policy formulation process due to high political and external conflict [ 25 , 28 , 30 , 37 , 53 ]. Moreover, due to poor engagement with policy players, fragmented governance and weak monitoring systems, some health policies do not meet their intended purposes [ 33 , 37 , 38 , 41 , 43 – 45 , 54 , 57 – 59 ].…”