Pre-Program Development Roundtable with health district authorities and Korhogo municipal staff.
Decentralization in Francophone West Africa has ushered in a new era of local governance, giving municipalities a crucial role in managing health services. However, this newfound autonomy comes with significant challenges: limited technical capacity, lack of funding, and complex coordination with national health systems.
This is where The Challenge Initiative (TCI) has made a difference, implementing an innovative approach that empowers cities to become self-sustaining leaders in family planning. As Amadou Diarra, Mayor of Pikine, Senegal, puts it:
TCI has transformed how we approach family planning and maternal health, fostering a unified and strategic vision. It has empowered mayors with the capacity to mobilize and secure domestic resources, ensuring sustainable funding for family planning initiatives.”
When Decentralization Becomes a Public Health Catalyst
TCI Model Marketing Session with Fara Soro, Second Deputy Mayor of Korhogo, Côte d’Ivoire, and municipal staff.
Imagine a city where local authorities don’t just follow national guidelines but actively lead the planning, financing, and management of reproductive health programs. This is becoming a reality in 28 cities across six countries – Benin, Burkina Faso, Côte d’Ivoire, Niger, Senegal, and Togo – due to TCI’s unique approach.
Municipalities progress through four phases of maturity as the intensity of TCI’s coaching declines:
- Lead: TCI trains elected officials and local actors to drive change.
- Assist: Municipalities gradually take over, receiving occasional support.
- Observe: TCI steps back, allowing the city to manage autonomously.
- Monitor: Only performance tracking remains as cities become fully independent.
In short, cities do not just receive temporary aid – they gain lasting expertise that they can employ going forward.
Remarkable Results Since 2016
- Scaling from 12 cities in 2016 to 28 cities in 2024, with 11 municipalities now fully autonomous.
- Mobilizing $1.14 million from local governments, demonstrating long-term commitment.
- Expanding family planning access: 197,239 additional clients were recorded between 2016 and 2024 – an 82% increase between 2023 and 2024 alone.
- Transforming policies through dedicated budget lines for family planning and the integration of high-impact practices (HIPs) into municipal strategies.
A Model for the Future
TCI’s success in Francophone West Africa shows that local, participatory approaches are often more effective than purely centralized systems. This model could inspire other regions to invest in similar training, local autonomy, and health innovation.
Joseph Gomado Koamy, Mayor of Commune Golf 1, Lomé, Togo, shares:
TCI is a great opportunity, and I never miss opportunities. Family planning is truly valuable, and I am living proof of that. My children are spaced by at least five to seven years. I am fully committed to family planning and have already made my first contribution to support its implementation.”
When Cities Take Charge: Ensuring Program Sustainability
A transformation is unfolding across Francophone West African cities. Thanks to TCI’s support, local authorities are no longer just implementing external directives – they are becoming the architects of their own family planning policies. But key challenges remain:
- Financing: How can stable funding be secured without initial external support?
- Advocacy: Will local advocacy groups maintain momentum once fully autonomous?
- Service Efficiency: How can data utilization and contraceptive stock management be optimized for long-term impact?
One thing is certain: local ownership is the key to sustainability. By equipping municipalities with the necessary tools and expertise, TCI is laying the foundation for a lasting revolution in reproductive health. Cities are no longer just beneficiaries of international aid – they are becoming self-reliant leaders, shaping healthier and more autonomous communities.
