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Healthy Cities for Adolescents Phase II (HCA-II) is a multi-country programme that supports projects working to improve adolescent and young people’s health and wellbeing in intermediary cities. Guided by the principle of shifting the status quo, with adolescents at the centre of this, HCA-II aims to catalyse meaningful changes in how cities function for young people. This guide aims to help you influence the systems that shape adolescent and young people’s health and wellbeing in the cities where they live. You don’t need to be a ‘systems expert’ to use it. It’s designed for anyone working on HCA-II projects (or similar) – whether you’re a project manager, Monitoring, Evaluation and Learning (MEL) lead, consortium partner or youth worker – who wants practical ideas for planning, delivering, and learning from work that aims to make cities fairer and healthier for adolescents. A core focus of this guide is helping projects shift system conditions – the underlying structures, relationships, and beliefs that shape how things work. It’s not about fixing everything at once, but about identifying where small changes, like who’s involved in decision-making, how resources are shared, or how people relate to one another, can unlock bigger, longer-term improvements. Focusing on how our work shifts system conditions helps us move beyond surface-level problems and get to the root causes, like policies, resources, relationships, and behaviours that shape adolescents’ lives. It’s a practical way of thinking and working that leads to more joinedup, fair, and lasting change. This guide is designed to be flexible; dip in and out depending on where you are in your project. It includes practical tools, examples, and ideas across five key areas of systems practice.