With the support of the Bill & Melinda Gates Foundation, Global Integrity launched a health systems strengthening project in collaboration with the African Health Innovation Centre (AHIC) and local partners to leverage participatory systems thinking approaches (PSTA) as a method to address various local health challenges. Global Integrity and AHIC partnered with the Centre for the Study of Adolescence (CSA) in Kenya and Ipas Southern Africa Region in Malawi over a 12-month period to address challenges related to adolescent sexual and reproductive health and rights (SRHR), especially for vulnerable populations including young women, persons with disabilities, sexual and gender minorities, and those seeking safe pregnancy termination. Over the course of a year, local organisations collaborated with key actors in their local ecosystems to identify challenges and ideate new solutions – tracking progress and roadblocks over the course of several months. The project concluded with one week in Ghana – exploring the West African ecosystem, meeting with key SRHR partners, and reflecting on the project process and outcomes.