Dr. Sangeeta Goel (center) shares TCI’s winning poster during ICUH 2024 in Marrakesh.
In November 2024, The Challenge Initiative (TCI) received an award for Outstanding Research Poster at the International Conference on Urban Health (ICUH 2024) in Marrakesh, Morocco. This recognition highlights TCI’s groundbreaking efforts to empower urban local governments in sustaining and scaling family planning programs, particularly through its innovative graduation model.
Since its inception in 2017, TCI has supported 214 local governments across 13 countries to implement high-impact family planning practices. Of these, 100 cities have successfully graduated from TCI’s direct support, with significant health outcomes sustained through local ownership and system strengthening.
Graduated cities are located in TCI’s four original hubs – East Africa, Francophone West Africa, India and Nigeria – and the poster (see below) reported on 86* that are continuing to succeed post-graduation:
- 1.4 million additional family planning clients from 86 graduated cities as of September 2024.
- 119% of the expected targets achieved, with notable success in East Africa (220%) and Nigeria (86.5%).
TCI’s model emphasizes institutionalizing family planning practices into local government systems, ensuring these interventions are not only scaled during TCI’s active engagement but also maintained post-graduation.
Key to Success: Empowerment Through Coaching
Central to TCI’s strategy is its coaching framework, which gradually transitions responsibility to local governments over a three-year period. This phased approach includes:
- Start-Up Phase (6 months): Intensive guidance to establish priorities using TCI University’s toolkits.
- Implementation Phase (18-24 months): High-impact interventions rolled out, with coaching tapering from “Lead” to “Assist.”
- Pre-Graduation Phase (6-12 months): TCI shifts to an “Observe” role, as local systems demonstrate readiness for independence.
- Graduation Phase: Local governments sustain programs with minimal on-demand coaching support.
This model fosters capacity strengthening, integrating family planning priorities into health plans and budgets while embedding TCI-trained coaches within local systems to ensure knowledge transfer and continuity.
While most graduated cities continue to implement proven interventions like postpartum family planning, there is some room to strengthen the adoption of adolescent-responsive contraceptive services and whole-site orientation. Addressing these gaps is essential to maintaining progress across all facets of family planning and adolescent reproductive health.
TCI’s award-winning research underscores the importance of letting local government lead to achieve long-term health outcomes. With over 36,000 TCI-trained coaches and a robust framework for sustainability, TCI will continue to monitor its graduated cities and provide additional coaching where results fall short of targets.
* TCI excluded three Senegal cities due to health worker strikes and 11 cities in India that implemented for less than 24 months.
