Barriers and Enablers to Youth Participation in Health Policy and Governance in Africa: A Narrative Review

Background: Although youth constitute a large and growing part of the African population, their participation in health policy and governance remains limited. Despite their size and social relevance, young people are largely excluded from the formulation of health policies, implementation, and governance, reinforcing cycles of inequities and poor system responsiveness. Objectives: This narrative review consolidates evidence on barriers and enablers of youth participation in health policy and governance across Africa. Methods: We performed a structured literature search across PubMed, AJOL, Google Scholar, and key organisational repositories (WHO, UNICEF, AU, and youth network databases) for studies and reports published between 2010 and 2025. Peer-reviewed and grey literature focusing on youth participation in health policy and governance, policy processes, and program evaluations within the African context were included. Non-health-related reports or studies focusing only on service usage and not conducted in Africa were excluded. A thematic narrative synthesis was used to identify common recurring barriers, enabling factors, and potential pathways linking youth voice to governance outcomes. Results: Major barriers include ineffective and/or tokenistic institutional mechanisms, deeply rooted age and gender hierarchies, insufficient funding and infrastructure, low levels of policy literacy and mentorship, and digital and geographic divides. Enablers included rights-based legal frameworks and national youth policies, sustained mentorship and capacity building, blended digital and face-to-face mobilisation, and formal participatory bodies with clear mandates. Four mechanisms for strengthening governance through youth participation were identified: formal representation, enhancing accountability and transparency, revitalising intergenerational trust, and increased system responsiveness that promotes equity. Conclusion: Effective youth participation requires sustainable institutionalisation, adequate resources, capacity building and support, active inclusion of underrepresented youth, and monitoring indicators that track quality of participation and its impact. Future research should prioritise longitudinal impacts of youth involvement, capacity-building models, and the development of a common set of indicators to assess participation.