In Tanzania’s Dodoma region, Chamwino District is home to more than half a million people – and a growing movement to improve reproductive health. At the center of this shift is Neema Mulula, a dedicated nurse and the District Nursing Officer at Chamwino District Council. Her commitment to family planning (FP) is both professional and deeply personal. One of Neema’s most memorable encounters with FP came when she delivered her third child.

It was the first time anyone had explained long-acting methods to me,” she recalled. “I was relieved to know I had a choice.”

Today, Neema works with local health facilities and The Challenge Initiative (TCI) to expand access to long-acting reversible contraceptives (LARCs), particularly the postpartum intrauterine device (PPIUD). She noted:

When women understand their options, they feel empowered. They can space their children, protect their health, and plan for a better future.”

That moment shaped her belief that every woman deserves the right to make informed decisions about her body and future.

Thanks to TCI’s coaching and tools, Chamwino has scaled services to 21 facilities, ensuring commodities and data tools are in place. Neema and other Community Health Workers (CHWs) now bring FP information directly to households, encouraging women to seek services – many for the first time. Since partnering with TCI, more than 20,000 women across Chamwino and other districts have adopted long-acting methods like the PPIUD.

We used to see women leave the hospital without any family planning,” Neema said. “Now, they leave with a plan – and with hope.”

But this progress wasn’t always guaranteed. Just a few years ago, health facilities were under-resourced, FP services were poorly integrated, and adolescent pregnancies were soaring. In 2021, 28% of teenage girls in Chamwino were pregnant before age 18. Neema explained:

Before TCI’s intervention, we had one of the highest rates of teenage pregnancies. Today, that number has dropped to 19.5%. This progress came from close collaboration with CHWs and structured AYSRH dialogues in schools and communities.”

TCI brought more than resources – it introduced a way of working centered on local leadership, data use, and sustainable planning. Health workers were coached to identify challenges and implement proven high-impact interventions tailored to their setting.

A key turning point came when Neema and her team began using whole-site orientations to engage all facility staff – from nurses to watchmen – in supporting FP services. She said:

When a client arrives, even the watchman knows where to direct them. Before, they might have left without help. Now, they’re welcomed and guided.”

Chamwino also prioritized CHWs to mobilize and educate the community.

Without proper community sensitization, it’s difficult to achieve strong turnout.”

Since TCI began supporting Chamwino in March 2022:

• The number of additional family planning clients has increased to more than 30,000
• The local government has spent 128% (nearly $107,000) of its committed $83,500
• Teenage pregnancy rates dropped from 28% to 18.5%

The impact has extended beyond numbers. Through coaching and planning support, the district now includes FP and AYSRH in its Comprehensive Council Health Plan. Neema said:

We’ve learned that you can’t implement without planning. If you want to do school outreach, you need fuel. You need a budget. Now we know how to plan for that – and we’re doing it.”

Chamwino’s journey shows what’s possible when local governments are trusted and equipped to lead. As TCI transitions out, the district stands ready – not just as a beneficiary of change, but as a driver of it. Neema said:

There are many achievements from TCI that we are proud of. But most of all, we now know what to do – and we have the confidence and tools to keep going.”