About The Challenge Initiative

The Challenge Initiative (TCI) is about rapidly and sustainably scaling up proven reproductive health solutions among the urban poor, building off of the demonstrated success of the Bill & Melinda Gates Foundation’s Urban Reproductive Health Initiative (URHI). The purpose of this scale up is lasting impact. Scaling without impact is empty scale; impact at scale without increasing cost-efficiencies is not viable; and cost-efficient impact at scale that is not sustained will not produce lasting change.

TCI delivers lasting impact through its business unusual model, which includes the following key features:

  • Demand-driven: Cities self-select to join TCI, bringing their own financial and human resources.
  • Local ownership and system readiness: Cities must be ready, willing and able to address their challenges.
  • Right-fitting proven interventions: TCI starts with evidence-based family planning and AYSRH interventions related to service delivery, demand generation and advocacy and helps cities to right-fit them for their particular context.
  • Coaching and TCI University: TCI uses a “Lead, Assist, Observe” coaching model to transfer capacity using TCI University, an online learning platform, to support coaching and capacity transfer.
  • Leveraging existing systems: Rather than working outside of existing systems, which can lead to duplication, waste and missed opportunities, TCI works within existing government- and community-led systems in order to harmonize strategies, plans, funding and technical assistance.
  • Near-time, real-time data for decision-making: TCI strengthens capacity to use data for problem solving and better decision-making.

Currently, the model is being applied to urban family planning and AYSRH, but TCI is in the process of proving that its business unusual model can be applied to any urban health area with success in terms of scale, impact, cost efficiency and sustainability.

Four-Stage Approach

TCI’s business unusual model incentivizes cities to have a high level of commitment and responsibility for serving the reproductive health needs of their citizens. The model’s four-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.


Stage 1

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

Stage 2

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.

Stage 3

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.

Stage 4

Become Self-Reliant

After meeting a set of criteria for “graduation,” selected cities from Stage 3 will transition to coaching on-demand. Support from TCI’s Challenge Fund will decline, but monitoring will continue. The city also becomes eligible for TCI’s alumni network and can serve as a resource for new cities engaging with TCI.