https://orcid.org/0000-0002-5902-8011
Africa’s 651 million children and adolescents are amongst those most impacted, set against a history of need, neglect, under-resourcing, and challenge. The Accelerating Achievement for Africa’s Adolescents Hub was established to provide pathways and insights for these young people to reach their potential, in contexts of HIV/AIDS, poverty, conflict, humanitarian crises, environmental degradation and now COVID-19. It aimed to bring together researchers from across the region, promoting early career academic success and to work with methodological innovation. The map below sets out locations across Africa where the Hub operated (see ).
Figure 1. Locations in which the Accelerate Hub has operated within Africa.
Our collaborative efforts have brought together adolescents and young people, academics, African and donor governments, UN agencies, and civil society. We have made new methodological advances in multilevel modelling and causal inference. We have co-worked with adolescent advisory groups, conducted systematic reviews of adolescent acceptability of services, and explored adolescent identities and lived experience across Africa. We have delivered randomised controlled trials through lockdowns. We have led ground-breaking cohort studies on some of Africa’s most left-behind young people: adolescent mothers, young people with disabilities, those facing unemployment, and those living with HIV. We have mobilised a multi-disciplinary constituency for impactful action.
This interdisciplinary approach has been fundamental in our scientific contribution to the Sustainable Development Goals: the identification, for the first time, of ‘SDG Accelerators’. This concept, developed by the UN Development Programme, represents policies and programmes that can benefit not only one but multiple SDG goals or targets simultaneously. Over 40 early-career academics across Africa and Europe have worked with mentors, resulting in over 150 peer-reviewed Hub publications over three years. We have – for the first time – found accelerators that can boost Africa’s youth to achieve the 2030 vision (Sherr, Cluver, Desmond et al., Citation2020), can identify vital components for the rapid regional transformation outlined in AU Africa’s Agenda 2063, can contribute to realising the global vision of the SDGs and their pledge to leave no one behind.
Accelerator concepts – a boosted paradigm
The first accelerator analysis was developed in 2019, in studying a cohort of South African adolescents living with HIV (Cluver et al., Citation2019). It used novel analysis techniques to allow for the correlated nature of multiple outcomes. It found that a government cash transfer, when combined with access to good parental monitoring and a safe school, was associated with substantially better outcomes across mental health, HIV care, school progression, safe sex, and freedom from violence and abuse than single provision. Whilst the exact causal mechanism is not yet fully understood, this research shows that there are real and measurable synergistic effects when services are combined. These evident synergies demonstrate how combined interventions can reinforce and enlarge positive outcomes, with the combination bringing far greater impacts than the sum of those produced by each constituent part in isolation. The potency of these combinations underpins the concept of ‘resilience building’, offering the substantial and sustained strengthening requisite for enduring capacity to cope with recurring challenges and crisis.
Since then, Hub researchers have identified accelerators across the region, clarifying the concept and enhancing the evidence base. Examples include: in Malawi and South Africa, food security, safe communities, and government cash transfers improved adolescents’ physical growth, mental health, and educational outcomes (Mebrahtu, et al., Citation2022); in Ethiopia, government sexual and reproductive health and rights (SRHR) education reduced child marriage and adolescent pregnancy and improved educational outcomes (Rudgard, Dzumbunu, Yates, Toska, Stockl et al., Citation2022); in Zambia, cash transfer, learning and mobile phone access reduced poverty and disability health restrictions and improved educational outcomes for adolescents in disability-affected families (Chipanta et al., Citation2022).
These observational findings are supported by randomised trials, including a trial in Kenya finding that a combination of cash transfer and motivational support improved economic and educational outcomes and reduced violence (Orkin, Citation2022). Emerging research from the World Bank (Bandiera et al., Citation2018), UNICEF (Palermo et al., Citation2021), and Population Council (Austrian et al., Citation2021) reinforces these findings.
These findings bring both a new theoretical paradigm and scalable solutions for Africa’s adolescents. They show real-world models of government and NGO-delivered services that are associated with better outcomes across multiple child and adolescent-relevant SDGs (see for examples of emerging accelerator evidence). They show that simple combinations (rather than complex packages) can work. They also show remarkable consistency in those simple combinations: We see clear emerging patterns of the effectiveness of cash transfers or social protection, combined with one or more of parenting support, sexual and reproductive health education, mental health support, and adolescent-friendly health services. This is by no means conclusive, but it does provide key insights for policy design and programmatic delivery, suggesting the value of a reassessment of funding prioritisation. Investing in demonstrably effective intervention combinations – at scale and with budgetary ingenuity – holds the greatest promise for realising the most impactful simultaneous co-benefits.
Table 1. Emerging accelerator evidence relating to Sustainable Development Goals.
Getting real: cost and scale
Our government partners have highlighted the fundamental importance of cost affordability and implementation feasibility. Importantly, Hub analyses have also provided insight into the quantum of interventions and provide guidance of when accelerator combinations plateau in their effect (Sherr et al., Citation2022). The data suggests that a combination of three interventions can maximise impact, and thus, serious attention should be paid not only to combinations but to factoring-in the presence of diminishing returns.
Translating such insights into optimised co-funding models is a next step, where co-benefits can be deliberately connected, even when streams are segmented by sectoral boundaries. See, for an example of the objective sets or incentives accelerator concept.
Figure 2. A visual example of the accelerator concept.
We are thus evaluating candidate accelerator interventions to identify efficiency enhancing approaches. In these cases, traditional cost effectiveness analysis is insufficient, as it biases decisions against interventions which have broader outcomes, or a range of outcomes which manifest across sector-specific incentive boundaries. Taking a whole-of-government holistic approach, we have been able to demonstrate that prioritising accelerators can improve outcomes more effectively than sector-by-sector selection of narrowly targeted interventions.
Realising these potential efficiency gains requires navigating public finance systems and both political and technocratic incentives (Guthrie et al., Citation2019). The Hub, in close discussion with policy makers, is developing financing approaches which will seek to balance efficiency and political motivations. These include an accelerator fund, which would allow sectors which identify accelerator opportunities to apply for additional funds based on a bid system.
An interlinked Hub
The scale and scope of the UKRI Global Challenges Research Fund’s Hubs allowed a unique formation of interdisciplinary linkages and shared learning. In our Accelerate Hub, six work packages tackled the crucial components of the project: Work Package 1 promoted policy engagement, including embedding researchers in the UN Development Programme (UNDP) and the African Union, and developing the policy skills of African early-career researchers. Work Package 2 focused on locally led cohort studies and analyses of secondary data, integrally facilitating exceptional capacity-sharing in statistical analysis and writing between Africa and the UK. Work Package 3 combined humanities-led understanding of identity and narrative (Boehmer et al., Citation2022), identifying the importance of family in providing adolescent-focused care, especially during pandemic conditions (Desmond et al., Citation2022).
Work Package 4 supported randomised trials to bring experimental data from South Africa and Kenya, and Work Package 5 brought together adolescent advisory groups, systematic reviews of adolescent acceptability of interventions (Somefun et al., Citation2021), and emerging cost-effectiveness models. In 2020, we introduced an additional Work Package for enhanced embedding of methodological rigor, with African and UK researchers focusing on statistical methodologies, particularly on improving causal inference. Whilst the overseas development aid cuts of 2021 meant that these Work Packages were not able to continue as envisaged, their advances remain, and the shared learning carries on.
Woven throughout all components of the Hub’s work are the interests and agency of adolescents. Existing as it does, to improve the lives of Africa’s adolescents, their views and voices are both foundational and integral, and our research and our commitment go hand in hand, most notably in the Hub’s Teen Advisory Groups (TAGs). These were established in 2008, with the aim to engage with adolescents as co-creators – research partners as well as study participants – of social science research, and to develop adolescent and youth-informed policy and programming recommendations. The Accelerate Hub has gone on to establish TAGs in Sierra Leone, Uganda, South Africa’s Eastern Cape province, and in Kenya.
TAG teen advisors have co-developed protocols for several Hub studies, and their inputs have directly influenced the Hub to conduct research with adolescent mothers, to focus on widened outcomes (particularly environmental issues), and to ensure their perspectives and priorities are communicated to high-level policy makers. The TAGs have pioneered innovative qualitative, participatory, arts-based approaches – further adapted to novel remote formats and methodologies during COVID lockdowns, when TAG adolescent advisors worked with Hub researchers to develop a sub-study collecting data on vulnerable adolescents’ real-time COVID-19 experiences, access to health services, health outcomes, and methodological lessons from remote engagement. Currently, TAGs in South Africa have been actively engaging in a ‘Design Accelerator’, working with researchers and representatives from the Department of Basic Education to support acceptable and evidence-based approaches to prevent adolescent pregnancies and to support adolescent mothers’ return to school.
Science for policy impact
The Accelerate Hub had an initial ambitious goal of reaching 20 million adolescents with evidence-based services. 3.5 years into the Hub’s life, this goal has already been profoundly surpassed. Through the direct work of Accelerate Hub researchers, over 220 million children have accessed evidence-based services (Blavatnik School of Government, Citation2022; Parenting for Lifelong Health, Citation2022).
This has been achieved through outstanding academic and policy impact of Hub key studies, and through the rapid development of new work in response to the COVID-19 crisis. Under the umbrella of the Hub a range of initiatives were launched, including:
In South Africa, the world’s largest study of adolescent mothers and their children – the Mzantsi Wakho-HEY BABY cohort – now working directly with UNICEF Eastern and Southern Africa Office to identify programmes for adolescent mothers, and with South Africa’s National Department of Basic Education to operationalise their new National Learner Pregnancy Policy (Roberts et al., Citation2022; Toska et al., Citation2022).
In Zambia, a major study on young people living in disability-affected households identified important impacts of social protection and mobile phone access on this under-researched group (Chipanta et al., Citation2022).
In Malawi and South Africa, a study found the capacity of local community-based organisations to have accelerator impacts (Mebrahtu, et al., Citation2022).
A study of parenting programme delivery has now collected data on over 50,000 participants across twelve African countries – and will provide the first regional data on scale-up of an evidence-based programme to prevent violence against children (Shenderovich et al., Citation2021).
In Tanzania, a new digital approach to evidence-based violence prevention is being developed and tested (Awah et al., Citation2022), and has been adopted by the national government for scale-up as a new national programme.
We have developed, and tested in a randomised trial, an innovative labour market toolkit for youth employment, which is being scaled-up in Rwanda and South Africa.
Under the Hub’s work packages, a wide range of initiatives were undertaken, including new analyses on existing data bases, new concepts, and the incubation of emerging conceptual ideas and novel ways of engaging adolescent perspectives and input. The Accelerate Hub responded to the global COVID-19 pandemic with speed and impact. Globally, the Hub has led modelling of COVID-associated orphanhood, publishing a series of papers and reports with the US Centers for Disease Control, World Bank, and WHO (Hillis et al., Citation2021; Hillis et al., Citation2022; Unwin et al., Citation2022). These have generated international policy recognition: a US Presidential Memorandum recognised the need to support US children bereaved by COVID-19, and our research findings were cited in President Biden’s opening speech at the 2nd Global COVID-19 Summit. We successfully advocated for a $2 m World Bank Rapid Social Response Program starting in 2023, to provide technical support for low-resource countries to request loans to support children affected by COVID-19. Briefing meetings with the Pope resulted in a Vatican statement on COVID-associated orphanhood.
We also pivoted the Hub’s work on family violence prevention to new and urgent COVID needs. Within weeks of the global lockdown in 2020, we brought together a partnership of WHO, UNICEF, UNODC, CDC, USAID, other key UN agencies, and 240 local non-governmental organisations in response to the crisis (-Cluver et al., Citation2020). We adapted evidence-based parenting programmes into parenting support resources comprising tip sheets, cartoon videos, TV and radio scripts, public service announcements, and social media messages, translated into over 100 languages and making all materials open-source and freely available. We shared these resources to every possible location and by all possible mechanisms: from community radio in Malawi, to disability-adapted versions with the Special Olympics, to loudspeakers in villages in Cameroon, in food parcels to refugee camps in Rwanda, and to innumerable other populations. Over 24 months, our evidence-based violence prevention resources were accessed by a minimum of 210.3 million people and incorporated into government COVID-19 response services in 33 countries. Qualitative studies and pre-post and retrospective surveys with 1,444 families in 12 countries reported reductions in parenting stress and violence against children and increases in positive parenting (Sherr et al., Citation2022).
We were also able to respond to a wide range of urgent COVID-related research needs, arising from and in collaboration with UN and government partners. For example, the Hub led two flagship UNICEF reports – one on risks and effective services for adolescents during COVID-19 (Sherr, Cluver, Tomlinson et al., Citation2020), and one on mental health of adolescents and youth in the pandemic (Sherr et al., Citation2021). In South Africa, we provided the government with evidence to design successful COVID-19 emergency social assistance packages reaching 13 million children and analysed national data on vaccine hesitancy for the Minister of Health. In each case, partnerships strengthened through the Hub’s earlier work allowed swift responses in a global crisis, whilst retaining the essential rigor of high-quality research.
The Hub has also initiated ongoing work with embedded policy impacts across multiple African governments. The University of Cape Town is leading in-depth work with five national governments and the Global Fund to End AIDS, Tuberculosis and Malaria, focused on providing new evidence to improve national-level planning and services for HIV-prevention amongst adolescent girls and young women. The outstanding success of the Hub’s policy engagement has been enhanced by a dedicated policy team, supported by the Oak Foundation to maximise policy impact.
From the origination of the Accelerate Hub concept in partnership with UNDP and UNICEF, the Hub team have maintained continual engagement with key policy partners, with a shared goal of improving the lives of Africa’s adolescents. At regional level, these partners include the African Union Development Agency-NEPAD, SADC, and UNICEF’s Eastern and Southern Africa Office. We are working closely with national governments – often in collaboration with UNICEF and Global Fund country offices – of South Africa, Lesotho, Zimbabwe, Sudan, South Sudan, eSwatini, Ethiopia, Nigeria, and Kenya. We have strengthened our partnerships in conceptual development and analysis with UNICEF, WHO, UNDP, the World Food Programme, UNAIDS, the Global Partnership to End Violence Against Children, and the UNODC, and are working closely with CDC, USAID-PEPFAR, and the World Bank on COVID-associated orphanhood. We have also built new collaborations with SIDA and FCDO key bilateral aid agencies.
All of this impact was achieved through the highest quality science. To date, the Hub has published more than 150 peer-reviewed papers in high-impact and local journals, and received eight achievement awards for impact. This demonstrates what it is possible to achieve through collaboration between outstanding researchers from across the global South and North, policy makers, and adolescents themselves.
Papers in this special issue
The Accelerate Hub initiated a new way of operating with multi-actor collaborations, North/South capacity-building, and applied research coverage. Funding cuts and contextual changes continue to present challenges, but despite these, this special issue collects an array of papers selected from across the working groups as an insight into the range and coverage of the initiative. This Special Issue provides a broad insight into emerging data and consolidates some of the many findings from the Hub’s work. By no means comprehensive, it serves as an introduction to the promising ideas and concepts around accelerators for adolescent achievement in Africa.
This compilation of 15 papers represents many facets of the Hub’s work. They represent a selection of some of the evidence emerging, but should be read in conjunction with the Accelerate Hub’s full range of publications on diverse topics and in multiple reports and peer-reviewed journals. The selection presented here clusters around growing evidence on three broad themes – accelerator benefits, insights into SDG challenges, and an understanding of how COVID-19 has affected the lives of adolescents in the region.
Accelerator insights
Haag et al. (Citation2022) explored which combinations of protective factors could improve the wellbeing of adolescents, using longitudinal data from 333 South African adolescents at age 12–14 years and followed up at age 16–19 years. The data showed that two protective factors (food security and safe environment) were positively associated with three mental health outcomes. Chipanta et al. (Citation2022) examined sustained receipt of accelerators in a follow-up study in South Africa, and showed that emotional and social support, parental/caregiver monitoring, food sufficiency, and accessible health care, by themselves and in combination, showed cumulative reductions across 12 negative outcomes. Kwabena Kusi-Mensah et al. (Citation2022) report on a study of 944 adolescents in Ghana to examine potential accelerators and targets. They underline the importance of three hypothesised accelerators – cognitive stimulation, low student–teacher ratio, and no relative poverty – as factors loading onto SDG targets, where a combination of all three was associated with elevated outcomes, thus directly indicating intervention potential.
Insights into SDG challenges
Steventon Roberts et al. (Citation2022) examine the risk factors for poor mental health among adolescent mothers in South Africa – noting particularly that violence exposure and a lack of perceived support are major risk factors. Stöckl et al. (Citation2022) report on a photovoice exercise evaluation in Tanzania. This depth study revealed hopes and aspirations in relation to livelihood opportunities, expectations, and education. Chen-Charles et al. (Citation2022) extended the insight into what adolescents value most and explored the impact of HIV status on such a value system, with a group of 1519 adolescents in South Africa. Aspirations and high value for education emerged, with clear implications for future policies and delivery initiatives. Awah et al. (Citation2022) report on the issue of transferring evidence-based parenting to an app-based intervention to enable broader reach and scale-up. Acceptability was high with potential for impact, yet barriers of access and literacy need to be confronted. Ibrahim et al. (Citation2022) explored the ramifications of lack of access to basic energy infrastructure, in a comprehensive systematic review. Of the 5083 studies identified on a keyword search, 12 fulfilled inclusion criteria showing electrification was associated with improvements in the quality of various services and medical supply chains. Basic attention to electrification of infrastructure, therefore, has a potential direct impact on SDG outcomes in LMIC. Jochim et al. (Citation2022) examined the importance of post-partum educational enrolment for 1046 adolescent mothers in South Africa. The data shows how adolescent motherhood can impede continued school enrolment and sheds light on the individual and service-level provisions that may be needed to positively influence schooling among this group. Kelly et al. (Citation2022) explored the experiences of health-care workers providing, and adolescents receiving, health-care services during the COVID-19 pandemic. The data highlights their different perspectives, the gap between the needs of youth recipients of services and their providers, and elaborates on the importance of health system investments to strengthen the delivery of adolescent services. Stöckl et al. (Citation2022) examined intergenerational impacts on education in Tanzania. Secondary school low attendance needs attention, and investment in the whole family is advised. The crucial issue of adolescent acceptability was addressed by Casale et al. (Citation2022), who explore consolidated findings on acceptability, aim to better conceptualise acceptability research with young people, and guide on contextualising findings on acceptability data. The importance of adolescent acceptability is a core thread in research and provision, which needs to be better understood.
Insights into COVID–19 context
Gittings et al. (Citation2022) explored adolescent voices on their priorities and was able to pinpoint variation and changes during the COVID-19 pandemic, illustrating how the new challenges may have helped evolve how adolescents face life challenges. Orkin et al. (Citation2022) provided a summary of evidence on the effects of cash transfers to inform the design of an urgent government response during the COVID-19 pandemic. The paper examines the benefits of cash grants in reducing hunger, increasing dietary diversity, and reducing secondary school dropout. They also explore evidence of how cash grants may encourage job search and economic activity, while confirming that there is little evidence that grants discourage working or increase spending on temptation goods. Grants can stimulate local economies, and although conditional payments may improve conditioned outcomes, the costs of implementing such conditions outweighed the benefits, especially in crisis contexts. Haag et al. (Citation2022) used longitudinal data to examine pre-COVID mental health and compare with repeat data collected during the first months of South Africa’s first COVID wave. The data showed increases in depression and anxiety, but not in alcohol use symptoms, during the COVID-19 pandemic. Socioeconomic deprivation was associated with higher symptom increases, as were negative experiences (e.g., household arguments and worries). Mental health needs matter for success in attempting to build a post-COVID normality.
The papers compiled in this Special Issue – and the many more Hub publications and reports not included – stand in testimony to the potency of the accelerator approach in addressing, and as important, in understanding, a myriad of challenges to realisation of the SDG and 2030 vision for Africa’s youth. The Accelerate Hub’s work to date has resourced this promising pathway with evidenced research and robust methodologies for further steps to be travelled by our team and others. Perhaps most important, the working model of collaboration, of interdisciplinarity and integration, of adolescent acceptability and inclusion provides a successful blueprint for future initiatives to attain accomplishment of SDGs for adolescents and the societies they can inspire and one-day lead.
Acknowledgments
The authors gratefully acknowledge the important and continuing contributions to Accelerate Hub’s work by the members of our Advisory Groups: Kola Aina, Kaumbu Mwondela, Nkandu Luo, Rayan Abdelmutaal, Samson Kinyanjui, Maru Mormina, Claire Heffernan, Gregory Meredith, Kelsey Shanks, Aggrey Ambali, Alex Butchart, Allison Oman, Brigette De Lay, Deborah von Zinkernagel, Damilola Walker, Fatimata Ba, Gretchen Bachman, Heather Doyle, Jason Wolfe, Laurie Gulaid, Maja Hansen, Marisa Vicari, Michelle Remme, Nazneen Damji, Nigel Rollins, Pamela Mason, Roshini Abedin, Shaffiq Essajee, Soyoltuya Bayaraa, Yogan Pillay, Elizabeth Modise, Catherine Sozi, Priscilla Idele, Stephen Blight, and the Members of the Adolescent Advisory Groups in Sierra Leone, Uganda, Tanzania, Kenya, South Africa, Nigeria.
We acknowledge with grateful appreciation Louise Gordon and Kathryn Steventon Roberts for their intensive work in bringing this Hub Special Issue to publication.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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References
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