SUB-SAHARAN AFRICA: Leave no one behind: integrated programming for adolescents and youth not in employment, education or training

Leave no one behind: integrated sexual and reproductive, mental health and psychosocial programming for adolescents and youth not in employment, education or training in sub-Saharan Africa: Commentary

BMJ Global Health 2023;8:8 (Open access)

by Manasi Kumar, Joan Mutahi, Beth Kangwana


  • Adolescents who are not in education, employment or training (NEET) are often left out of the health and social programming. This is a disproportionately large group in sub-Saharan Africa that has experienced extreme marginalisation during the pandemic.
  • Countries where young people are left behind and not cared for will struggle to achieve sustainable development and progress.
  • Health interventions especially psychosocial programmes and services are needed to understand their unique needs and develop responses towards bringing them back into fuller participation in various social institutions and opportunities that would build their capacities and protect their rights.

A systematic review found significantly high prevalence of depression, anxiety disorders emotional and behavioural difficulties, post-traumatic stress and suicidal behaviour in the general adolescent population covering 16 sub-Saharan African countries with significant risks of developing long-standing mental disorders in orphaned children, and those living in poverty. Mitigating the socioeconomic determinants that increase the risk for the above difficulties in adolescents and youth (as identified in the United Nations’ SGDs) could be achieved through integrated interventions. These interventions would work closely with families and communities in the promotion of effective and accessible basic provision including education and resources to empower the population in decision-making and targeting competencies such as development of self-efficacy to potentially bridge their psychological, economic, sexual and reproductive health-related gaps.


In our work we learned from the young people that livelihood programmes or short training courses with a strong practical component may be attractive to NEETs who cannot or will not go back to school due to lack of interest in academics, or frustrated by their previous schooling experience or, possibly, struggling with social and health issues. This demographic may include pregnant or parenting adolescents and youth, including those living with chronic health conditions due to HIV, cancer, disabilities, etc.

We need a focused effort towards finding solutions for the socioeconomic marginalization that such vulnerable populations face. Only integrated programming that prioritizes whole-of-health approach building in mental and behavioral health for NEET adolescents will address their increasing marginalization from and lack of meaningful participation in society.