Young migrants in South Africa and Zambia are being locked out of sexual and reproductive health services because the system is designed for people who stay put. This matters because mobile adolescents and young people (mAYP)—those who move for work, family, or safety—often cannot prove residency, lack documentation, or are turned away by clinics that assume they belong elsewhere. The result is poor sexual health, including untreated infections and unintended pregnancies, in a population that already faces high vulnerability. Existing services rarely account for mobility, and young people themselves are seldom asked what would actually work for them. If this research succeeds, it will produce interventions co-designed with mobile youth that help them recognise their eligibility for care and push clinics to become more responsive. The project will also train early-career African researchers to lead this work, shifting power away from UK-based institutions. By year four, the team expects to have pilot-tested feasible, acceptable approaches that could be scaled by health ministries in both countries. The impact is not a new drug or device—it is a redesigned pathway into care for people who move.
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BACKGROUND In South Africa and Zambia mobile adolescents and young people (mAYP) make up a significant number of the people who migrate. Migration limits mAYP access to health services including access to sexual and reproductive health rights (SRHR) information and quality services, leading to their poor sexual health. Addressing this situation requires an interdisciplinary approach rooted in African-led research, placing mAYP at the centre of defining and solving the problem. In our partnership we will address the SRHR of young migrants by creating lasting interventions with young people to raise awareness of their eligibility for SRHR services and promote the responsiveness of those services, working with health providers, responding to demand from key national stakeholders and drawing on past work. AIMS AND OBJECTIVES We aim to conduct policy-relevant research to enhance mobile adolescents and young people’s ability to navigate access to SRHR services, thereby contributing to their improved health and wellbeing. Our objectives are to: a) Synthesise evidence that examines causation in youth-led health research to identify effective approaches and emergent processes to enhance health systems responsiveness and improve access to SRHR services for mAYP in southern Africa. b) Anchored by youth-led social mobilisation, to co-develop and implement interventions with young people that support mAYP to recognise their candidacy and access SRHR services, working with health-care stakeholders to identify ways to make care more responsive to mAYP requirements. c) Co-produce and use a participatory monitoring and evaluation process in the piloting of the co-developed interventions, assessing their feasibility (including resource needs), acceptability, and equitable reach. d) Continuously engage and involve communities and other stakeholders to encourage and facilitate youth-led mobilisation to nurture their resilience and support facility/provider responsiveness to the health and well-being needs of mAYP. e) Consolidate and strengthen South African and Zambian researcher’ skills and agency to navigate the inequitable power dynamics in health research, promoting their visibility and shared intellectual leadership across Zambia, South Africa, and in the UK, to influence practice and policy in relation to the health and wellbeing needs of mAYP. METHODS Y1: Evidence synthesis of literature and databases/websites and existing data sets. Preparatory co-development of theory of change with young people engaged as advisers. Y2: Rapid participatory qualitative methods, a baseline survey and establishment of a qualitative methods cohort. Co-development of intervention(s), and processes for monitoring and evaluation. Intervention piloting starts. Y3: Continued qualitative and quantitative data collection for participatory process monitoring of the intervention and evaluation. Y4: Analysis and writing up, case studies of interventions co-developed with mAYP and other stakeholders and findings disseminated. Community engagement and involvement, and training and capacity strengthening activities planned across all years. IMPACT By the end of the project, we will have developed interventions to improve mAYP access to SRHR services; co-created systems to monitor health service responsiveness; supported identifiable youth-led approaches which enhance mAYP visibility; and, by year 4, established early/mid-career African researchers as research leaders.
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