Youth participation in public policy making : critical analysis of young people’s involvement in the National Health Insurance policy submissions using Societal Constitutionalism as a theoretical framework

Abstract

Youth engagement in public policy is a widely trumpeted notion supported by participatory democracy as espoused in various legislative and policy instrument; however, the interventions associated with this commitment do not easily produce the progress sought. This can be seen in the concerns that continue to be raised regarding youth participation in development. The National Health Insurance (NHI) policy in South Africa is one such development venture with a low youth presence which – although having implications on the social reality of the young people of today and into the future – appears to not include them as key stakeholders in the consultation process. The aim of this research study is to unpack the participation of young people in public policy making and strengthening in South Africa, with specific reference to the NHI commentary process. To achieve this goal the following key texts and informants were drawn upon: qualitative in-depth interviews with a majority of the 20 contributors to the Young People’s Recommendations (YPR) on South Africa’s NHI White Paper; and detailed, qualitative document reviews of the Dullah Omar Institute’s report titled ‘Decision Making on Health in South Africa – What Can We Learn from National Health Insurance (NHI); as well as the Department of Planning, Monitoring and Evaluation’s report titled ‘Socio-Economic Impact Assessment System’s Final Impact Assessment (Phase 2): White Paper on NHI’. Triangulating between these sources and other key texts and accounts, the study unveils important influences behind the quality and extent of youth participation in public policy. This study shows that the absence of young people in the conversation around NHI is not due to a lack of knowledgeable input and effort from young people, but rather a cocktail of influences that have to do with the blatant – but ill-acknowledged – politics within the health policy consultation process. Chapter Four contains the bulk of these voices and my analysis of this activism. The theory of societal constitutionalism that this study employs assisted in uncovering the reality that these young professionals are capable, knowledgeable, informed, concerned, and resilient – and that they are still determined to act within the space of public health. This finding directly contradicts the perception that the youth are vulnerable people that can only be theorised “upon” and “about”, not “with”. After detailed analysis of the data from and by youthful people collected for this thesis, the Conclusion of this study shows that it is not a lack of policy that impedes youth participation in policy making and sustenance; it is the marginalising attitudes and ideologies which then influence how the youth are considered in the conversation. This observation highlights the disconnect between policy and practice which can be addressed through interrogating both policy and process, especially through critical engagement with the practised reality.