ADOLESCENT HEALTH & WELLBEING
@Henry Magoba Thank you so much for bringing this questions for a discussion.
Dr. Magoba, thank you for framing this as
structural rather than programmatic — it's the right level to be asking these
questions at.
I want to push on two of your nine, because I
think they're actually one question in disguise: how adolescent voices get
incorporated, and how interventions address interconnected risks rather than
single outcomes. The Second Lancet Commission on Adolescent Health and
Wellbeing, launched at the World Health Assembly in 2025, is useful here. It
argues for a "triple dividend" — benefits to adolescents now, to
their adult selves later, and to the generation after them — and one in seven
adolescents worldwide currently lives with a mental disorder, against
strikingly low investment. Among its five recommended levers, the Commission
names engaging adolescents as co-leaders and designers, not simply as consulted
subjects, alongside reforming existing services and working across sectors
beyond health.
At Purpose Rwanda, our peer-led PAT model is
essentially a live test of that lever, though our population is young people in
recovery rather than adolescents broadly. What we've observed is that when a
young person moves from being served to being the one who delivers support to a
peer, two things change simultaneously: their own resilience improves, and the
programme itself becomes more structurally responsive, because the person
shaping the intervention has lived the barrier being addressed. That's not incidental
— it's the mechanism. Structural determinants like stigma and service
inaccessibility are, in a peer-led model, being addressed by the exact people
who experienced them, not on their behalf.
Where I'd push back gently on the
"single-entry-point" service-bundling approach Nonvicks raised above:
bundling sexual health, mental health, nutrition, and substance-use prevention
into one access point solves a discoverability problem, but it doesn't by
itself solve a trust problem. Adolescents who don't trust adult-designed
systems won't walk through a well-designed door either. The Commission's
emphasis on co-design isn't just about better programme fit — it's a trust
mechanism that service integration alone can't replicate.
So my honest addition to your list of questions:
beyond "how can adolescent voices be meaningfully incorporated," I'd
ask — at what point does incorporation become governance? Advisory boards and
paid co-design roles are progress, but they still position adults as the ones
who decide how much say to grant. Peer-led models suggest a further step is
possible. I don't think we have strong African-context evidence yet on what
happens to structural outcomes when adolescents hold actual programmatic
authority, not just design input. That may be the real evidence gap beneath
several of your questions at once.
I think we need to look beyond the health facility when we talk about adolescent wellbeing. Issues like education, family and community support, poverty, gender norms, digital access, and the information young people receive all play a role.
For me, one of the key things is also making sure adolescents are part of the process—not just as beneficiaries, but in shaping the research, programmes, and solutions from the beginning. We also need stronger links between research and practice so that evidence translates into policies, tools, and interventions that actually work in their everyday lives.
Perhaps the bigger question is: how do we build systems that not only respond to adolescents’ needs but also give them a meaningful role in shaping those systems?
Thank you, Nonvicks, Charles, Desmond, and Rhoda, for these thoughtful and complementary perspectives. I particularly appreciate how the discussion has moved beyond what services adolescents receive to who has power to shape those services, how systems interpret their needs, and whether interventions produce sustainable structural change.
Nonvicks, your emphasis on multisectoral action, integrated services, age-disaggregated information systems, and longitudinal measurement highlights the need to address adolescents' risks as interconnected rather than isolated programme indicators.
Charles, I strongly agree with your distinction between participation and governance. Co-design, advisory boards, and peer involvement are important, but the more transformative question is whether adolescents have legitimate decision-making authority. Your observation that peer-led models can simultaneously address individual resilience and system responsiveness is particularly important.
Desmond, your point about looking beyond the health facility is fundamental. Education, poverty, family environments, gender norms, digital access, social protection, and community structures can determine whether an adolescent is able to benefit from health services in the first place.
Rhoda, your challenge on who interprets the data is especially compelling. Disaggregating routine data by age, sex, geography, and socioeconomic characteristics is necessary, but insufficient. We need participatory interpretation that allows adolescents and communities to explain the barriers behind the numbers.
Bringing these perspectives together, I think the deeper agenda is accountability and power: moving from adolescent beneficiaries → participants → co-designers → co-governors of health systems.
Of my original questions, I believe the most under-answered is therefore: How can African health systems institutionalize adolescent decision-making power and demonstrate that this power produces measurable improvements in equity, trust, service responsiveness, and long-term wellbeing?
We have increasing evidence on service models, but considerably less evidence on whether shifting decision-making power to adolescents changes systems themselves. That, in my view, is a critical frontier for adolescent-health research and implementation across Africa.
I must say i love the questions and the replies made. I believe adolescents would can be helped when they are co-designers of their own interventions. This is because they understand their challenges more and are quick to say what is not working.
A lot of research has gone into adolescent health yet policies have not been able to address major glaring issues. Our main fear as programmers and adults is thinking they do not have the capacity to make informed decisions, and therefore we rarely give them platforms do so.
Martha, your Turkana study is a genuinely useful
concrete test case for exactly the "governance versus participation"
question Dr. Magoba named as the thread's core frontier. Child early and forced
marriage is a particularly sharp setting to explore adolescent decision-making
capacity in, precisely because it's the context where adults are most likely to
say "they cannot decide for themselves" — and where the actual evidence
on adolescent judgment, once genuinely consulted rather than assumed incapable,
tends to complicate that fear rather than confirm it.
I want to push gently on the phrase "our
main fear as programmers and adults." I think that fear deserves to be
named more precisely than a general anxiety about capacity — in patriarchal
community settings specifically, it's rarely just adults underestimating
adolescents' capacity in the abstract. It's adults protecting an existing power
structure that adolescent decision-making authority would directly threaten,
particularly around marriage, where the adult decision-makers often have real
social or economic stake in the outcome. That's a harder problem than a
knowledge-attitudes-beliefs intervention alone can solve, since KAB approaches
assume the barrier is informational, when in this specific case, the barrier is
frequently also about who benefits from adolescents not deciding.
Does your study design have a way to distinguish
between those two different barriers — genuine capacity-belief among adults,
versus power protection dressed up as capacity concern? I ask because the
intervention that works for one is likely to fail against the other, and I
suspect most KAB-framed studies in this space don't cleanly separate them.