'Youth need to be at the decision-making table, period'

Malvikha Manoj's work has always been about uncovering the unseen. At high school in the United Arab Emirates, she was part of a cohort of students who convinced administrators to create a new set of courses that combined science and psychology by showing them how the two disciplines were tightly interconnected.

As co-executive director of the International Working Group for Health Systems Strengthening (IWG), which she co-founded while studying for her master's degree at the Johns Hopkins Bloomberg School of Public Health, she helps connect young local and global health professionals from all over the world so they can bring attention to health issues that rarely make the headlines, such as period poverty in Lebanon or how frequent power cuts wreak havoc on South Africa's healthcare system.

And in her work as a data and analytics consultant for UNICEF's mental health portfolio, she uses numbers to find and give voice to hundreds of thousands of children and adolescents who are underserved by mental health systems.

Along the way, Manoj, who is also a research associate at Johns Hopkins, has authored or co-authored studies and articles on some of the biggest issues facing the global health sector today, from vaccine inequity to global health decolonization to how the COVID-19 pandemic has reshaped global health education.

Driving her work, she says, is the energy and support she gets from a vast community of young researchers, academics, and health professionals who are all striving to improve health systems and structures for their communities, their countries, and the world.

"If you have a community of individuals, especially from around the world with different kinds of experiences, coming together to shout for the same thing, you can be more audacious in your goals and in reimagining a better health system that works for everyone," she says.

For our International Youth Day Series, Exemplars News spoke with Manoj about making sure young people count when it comes to mental health systems and the importance of youth voices in shaping the future of global health.

Part of your work uses data to analyze youth mental health systems in the Middle East and North Africa. How does data help build effective mental health policies and programs?

Manoj: There is this one statistic that I go back to a lot: especially in lower- and middle-income countries, available data covers around 2% of the adolescent population. That's concerning, to put it mildly. If we only know enough about 2% of the adolescent population, that means so many young people's mental health needs are being unseen, unmet and undermined.

Data can help fill those gaps and ensure that when we're advocating for change, we have evidence to back it up and we're including the voices of people who are most impacted by it.

But it's also important that data is understood in the context that we're working in, whether that's historical context, cultural, or geopolitical. Data cannot really be objective if we are using it without considering the broader influences that might have shaped why someone's not accessing mental health care or why mental health is a stigmatized issue in that country.

With youth mental health, that means ensuring that young people are shaping not just the results, but how we're collecting data and using it across the data cycle. Is the language we use in data collection relevant to young people? Is it capturing the concepts of mental health they think are important? That way, young people can also use the data in their own advocacy efforts. Because we're seeing more and more youth-led efforts for mental health that are using data-driven advocacy for action.

Are there any projects or campaigns you've seen that succeed in effectively engaging young people on mental health?

Manoj: There is a UNICEF-led effort to measure mental health among adolescents and young people called MMAP (Measuring Mental Health Among Adolescents and Young People at the Population Level), which I’ve had the privilege to work with. One of its unique features is that before it's implemented in any new context, the data collection module has to be culturally adapted by both local mental health experts and young people themselves. So, the project has more buy-in right and is fit for purpose right from the start.

Another example is the Shamiri Institute, a youth-led organization that trains local young people work hand-in-hand with counselors to provide tiered levels of support. There's community-level support, a peer-to-peer level, and then, for crisis situations, there are mental health professionals on-hand. It's for the community, with the community, by the community, which means young people are more aware of and engaged with the mental health support it offers.

What does the broader global health sector need to do to better address the mental health concerns of young people?

Manoj: Listen to young people. You can't call it a youth-led or youth-engaged mental health intervention and have an adult at the top pulling all the strings. Youth need to be at the decision-making table, period.

We also need more robust accountability metrics for youth-engaged initiatives, whether that's for mental health or climate change or food systems. We need to be measuring how an intervention works and what qualifies as success or failure. Those frameworks exist, but the global health sector can do better at implementing them.

And, of course, we have to mention funding. So many youth-led organizations I know have started off entirely unfunded or are still unfunded. Young people see a need, they come together, they're investing time outside of school or work, all because they are committed to meeting that need. There are young people who are passionate, mobilized and have solutions. Global health funders and donors should recognize that and provide funding, support, and resources. And that doesn't necessarily mean only financial resources – it could be simply ensuring young people have space to tell their stories.

The sector also needs to meet young people where they're at – home, schools, communities. There is an initiative in South Africa called Waves for Change, where adults in the community who surf give lessons to young people. And these surf mentors are trained on basic psychosocial skills and adolescent development, so they can be consistent, positive mental health caregivers to the youth they teach.

Projects like that recognize social connectedness as a key feature of positive mental health outcomes. You cannot address mental health just by addressing mental health in silos. Physical activity, nutrition, climate change, these issues are all interconnected with mental health. So, we also need more cross-sectoral programs to have more of a system-strengthening approach rather than a fragmented effort.

Why is it important that young people's voices are included in the process of designing, implementing, and reshaping global health systems?

Manoj: It's about inclusion and representation of diverse voices. The problem isn't the lack of solutions, it's the lack of solutions that get heard or chosen or funded, and those factors are determined by who is at the table.

One big lesson I've learned is that anyone can be engaged in public health if they're interested in it. Initially, when we spoke about creating the IWG it was for public health professionals. But we've changed our language and now we say it's an organization for changemakers, because it's open to anyone committed to change. And you don't have to have a degree in public health to do that.

Achieving health for all means bringing together people from tech, people from arts and humanities, people from different areas and expertise to work on their interests in public health. And this is especially important for youth and young emerging professionals, because we are inheriting this system.

This interview has been edited for length and clarity.