More than half of the world’s population currently lives in cities and this urbanization is accelerating to 70 percent by 2050, especially in Africa and Asia. Cities benefit from economic growth, but also struggle to accommodate rising demands for services. Cities are home to growing, underserved poor communities.
Building off evidence from the Urban Reproductive Health Initiative (URHI), The Challenge Initiative aims to deliver impact and sustainability. Our model is based on rapidly scaling up and sustaining proven reproductive health solution for underserved urban poor communities by transferring key knowledge and skills that build on past experiences, and cultivating a culture of learning, exchange and continuous improvement.
We do this by:
- Being demand-driven: Cities self-select to become a part of TCI, by submitting an expression of interest that articulates their political as well as financial commitment to implement TCI proven interventions. We put cities in the driver’s seat, while providing them technical support to design their own family planning and AYSRH programs based on the proven interventions that meet the local needs, constraints and opportunities of their particular context.
- Coaching: Supporting cities with technical support and guidance from our regional accelerator hubs, tools and resources from TCI University, and minimal funding to complement their resources to implement the proven interventions themselves.
- Focusing on local commitment and system readiness: Engaging cities that demonstrate their willingness, readiness and ability through political and financial commitments to address their reproductive health challenges in places that have adequate infrastructure and resources but weak programming and limited coordination.
- Leveraging: Coordinating our efforts with allied interests.
- Utilizing data: Ensuring that in our engagements with city partners, we are strengthening capacity to problem-solve and utilize data for better decision-making.
The expected outcome is an increase in the use of modern contraceptive methods among all women 15 to 49 years of age in urban poor areas as a result of more local governments replicating and adapting proven family planning and AYSRH interventions, while at the same time better utilizing their own resources to do so.
The Initiative believes its demand-driven model incentivizes cities to have a high level of commitment and responsibility for serving the reproductive health needs of their citizens. The model’s three-stage process is intended to prime local ownership at the outset and nurture a leading role for cities in program design and implementation. These stages also provide visibility on the appetite for change that exists in many vibrant urban communities.
Like no other project before, the Urban Reproductive Health Initiative (URHI) was designed specifically to address the urban poor and their reproductive health needs. URHI was a Bill & Melinda Gates Foundation-funded multi-country program in India, Kenya, Nigeria and Senegal that aimed to improve the reproductive health of the urban poor by increasing the accessibility, quality and use of family planning services. From 2010-2016, the projects used different interventions, both demand and supply side, to increase use of and access to contraceptives.
From baseline to endline, it achieved increased modern contraceptive prevalence (mCPR) especially among the poorest quintiles, improved knowledge around modern methods and saw large increases in use of long-acting and permanent methods including implants, IUDs and, mostly in India, female sterilization. These increases were observed among all women and across the wealth groups. Although URHI was not an adolescent-focused program, there were significant impacts among young people and important lessons learned – particularly from the Nigerian and Kenyan contexts.
URHI was a “proof of concept” to figure out what works where and why. Watch The Key to Sustainable Development: Investing in Urban Reproductive Health to understand how we moved from URHI to the Initiative and why investing in urban reproductive health is so important.
Submit an Expression of Interest
A city should contact the Initiative to signify its intent to join. One of our hubs will work with the city to document and validate the city’s interest. The city will be asked to provide the following in the expression of interest form:
- Evidence of political commitment
- A description of health system capacity
- An account of demographic need
- A pledge of local resources (funding or in-kind) to contribute to the implementation of a TCI proven intervention
Design a Program
A city that qualifies from Stage 1 will gain access to TCI University and its outstanding package of practical learning tools on proven and high-impact family planning and AYSRH interventions and approaches. The city will receive technical support from the Accelerator Hub to identify gaps and design a program that fills the most critical ones. The city will be asked to outline funding needs in its program design and confirm the local resources they can contribute towards the proposed program.
Implement a Program
A city with a promising program design that meets the criteria for soundness and cost-effectiveness will receive financial assistance from the Initiative’s Challenge Fund. This subsidy to implement the approved program will go hand-in-hand with technical coaching and mentoring from the hub. The city will also join the Initiative’s global Community of Practice, where it learn from other implementers and share proven best practices in delivering quality family planning and reproductive health services. In select cities, the Initiative will set up a monitoring tool to track progress and provide immediate feedback on what is working well and what needs adjustment. The Initiative will strive to marshal the needed resources to sufficiently respond to the demand for technical and financial support, while at the same time ensuring this support flows to cities with programs with the best likelihood of success.