The Challenge Initiative (TCI) had a strong presence at the 25th Annual Population Research Conference, hosted by the Population Association of Pakistan (PAP) in Karachi in December 2024. The team shared insights from its family planning (FP) programs through eight poster sessions and one oral presentation, highlighting effective, evidence-based strategies and lessons learned.

The conference brought together public health professionals, researchers, and policymakers to explore data-driven solutions to public health and sustainable development challenges. TCI showcased its commitment to community-centered, locally led health interventions. TCI Knowledge Manager Junaid ur Rehman Siddique was recognized with the second-best poster presentation award.

Summary of Research Presented:

A Biannual Evaluation of Healthcare System Performance Using the RAISE Tool in Karachi Division and Hyderabad Districts
Author: Irum Imran, MLE Sindh

This study examines the impact of biannual RAISE (Reflection and Action to Improve Self-Reliance and Effectiveness) assessments implemented by TCI on health system performance in seven districts of Karachi and one in Hyderabad over a 2.5-year period. TCI supports local governments with technical assistance, seed funding, and a package of high-impact practices and interventions (HIPs and HIIs) to improve access to reproductive health and family planning services. The RAISE tool uses 19 indicators across six health system building blocks to guide structured assessments, identify gaps, and support action planning. Over six evaluation rounds, all districts showed significant improvements. For example, East Karachi improved from 37% to 63%, and Hyderabad from 37% to 69%, reflecting stronger implementation of HIIs and better overall health system performance. The results underscore the value of the RAISE approach in fostering strategic reflection and improving service delivery, while pointing to the importance of ongoing monitoring and research to sustain and build on these gains.

Enhancing Contraceptive Adoption through Women’s Health Services: The Impact of Capacity Building & Coaching in 8 Districts of Karachi & Hyderabad
Author: Irum Imran, MLE Sindh

This study assesses the impact of TCI’s capacity-building and coaching efforts on increasing contraceptive uptake across eight districts in Karachi and Hyderabad. Working with local governments, TCI introduced high-impact interventions (HIIs) to strengthen family planning (FP) service delivery in the public health sector. Between September 2022 and June 2024, TCI trained 1,918 Lady Health Workers, 135 Lady Health Supervisors, and 210 community health workers (CHWs) through a cascading, “trickle-down” training model. These efforts were supported by community engagement activities such as FP-focused events, health melas, and distribution of information, education, and communication materials. Data from 315 of 321 eligible facilities showed strong results: 429,855 women participated in 1,931 Family Health Days and satellite camps, with 143,921 (50.3%) choosing FP services. According to the Health Management Information System, FP commodity consumption rose by 139% and service uptake by 140%. These outcomes suggest that TCI’s interventions contributed to more than half of all reported FP clients, demonstrating the effectiveness of integrated, women-centered services. The findings reinforce the importance of sustained community engagement, policy integration, and institutionalizing HIIs at the provincial and national levels to ensure long-term impact.

Impact of TCI High-Impact Interventions on LARC Client Volumes in Public-Sector Facilities across Six Districts in Punjab and Islamabad Capital Territory, Pakistan
Author: Junaid ur Rehman Siddiqui, Knowledge Manager

This study evaluates the impact of TCI’s HIIs on the uptake of long-acting reversible contraceptives (LARCs) in public-sector health facilities across six districts in Punjab and the Islamabad Capital Territory (ICT), Pakistan. In collaboration with local governments, TCI supports improved access to reproductive health services through a range of strategies, including capacity building for clinical and community mobilization staff, integrated mobile outreach, satellite camps, Family Health Days, facility upgrades, stakeholder advocacy, influencer engagement, and data-informed service delivery enhancements. Monthly LARC client data from the Contraceptive Logistics Management Information System (cLMIS) was analyzed from June 2020 to July 2024. TCI interventions were introduced starting in June 2022, with rollout timing varying by district. Two-sample t-tests comparing pre- and post-intervention periods showed statistically significant increases in average monthly LARC clients. In ICT, client numbers rose from 663 to 1,224 (an increase of 561; p<0.000), while Punjab overall saw an increase from 1,152 to 2,742 (an increase of 1,590; p<0.000). District-level gains were also substantial: Multan (+1,811), Faisalabad (+1,794), Lahore (+1,768), Rawalpindi (+1,597), Gujranwala (+1,558), and Khanewal (+1,009), with Multan recording the highest monthly average of 3,551 clients. These results demonstrate the effectiveness of TCI’s integrated approach in boosting LARC uptake and highlight the importance of continued investment and stronger government ownership to sustain and expand these interventions for broader family planning impact in Pakistan.

Impact of TCI’s Community Health Workers High-Impact Intervention on Public Sector Service Provision of LARCs in Urban Sindh, Pakistan
Author: Junaid ur Rehman Siddiqui, Knowledge Manager

This study examines the impact of TCI’s community health worker (CHW)-related HII on the uptake of long-acting reversible contraceptives (LARCs) across eight urban districts in Sindh, Pakistan. In collaboration with the Sindh Population Welfare Department, TCI supports local governments with technical assistance and challenge funding to scale up evidence-based family planning (FP) interventions. The analysis draws on monthly contraceptive performance data from June 2020 to July 2024, sourced from the Contraceptive Logistics Management Information System (cLMIS). It covers public-sector facilities managed by the Department of Health (DoH), Population Welfare Department (PWD), and PPHI across Hyderabad, Karachi Central, East, South, West, Keamari, Korangi, and Malir. CHWs became operational in these districts between January and October 2023. A binary variable for CHW operationality was used in statistical analysis, which included descriptive statistics, two-sample t-tests, and linear regression. Results showed significant increases in IUD services (from 148 to 236 units), implant services (from 179 to 271 units), and overall LARC uptake (from 327 to 508 units), all with p<0.000. Regression analysis found that CHW presence accounted for 10% of the variance in IUD uptake (β=0.24), 21% in implant uptake (β=0.24), and 24% in total LARC use (β=0.30), indicating a strong positive effect. These findings highlight the critical role of CHWs in expanding access to LARCs in urban areas and emphasize the need for ongoing investment in their recruitment, training, and integration into the public health system to strengthen FP outcomes.

Profiling the Contraceptive Market for Married Women of Reproductive Age in Pakistan Using PDHS 2017-18
Author: Junaid ur Rehman Siddiqui,  Knowledge Manager

This study examines the contraceptive market among married women of reproductive age (MWRA) in Pakistan by quantifying demand for modern family planning (FP) methods. It draws on data from the 2017–18 Pakistan Demographic and Health Survey (PDHS), Multiple Indicator Cluster Surveys for Punjab and Sindh, and the 2023 Pakistan National Census. The analysis is designed to inform strategic FP planning in 15 urban districts, including seven in Punjab. Focusing on MWRA aged 15–49, and excluding the 21.4 million unmarried women per PDHS methodology, the study assessed demand, unmet need, and current contraceptive use. Of the 57.6 million women of reproductive age in Pakistan, 18.1 million married women have a need for modern contraception. Among them, 8.6 million are current users (2.6 million of whom are expected to discontinue within a year), 5.4 million are intenders (planning to use in the future), and 4.1 million are non-intenders. Attitudinal analysis showed that intentions to use FP are closely linked to beliefs about contraception. Market projections suggest that converting intenders into users presents a major opportunity for impact. In addition, targeted counseling could help shift attitudes among non-intenders. If both groups were successfully converted, Pakistan could reach 15.5 million MWRA users, which is 71% of the national target of 21.9 million by 2025. These findings offer clear policy direction for prioritizing interventions and allocating resources in FP programs.

Community Health Workers and Social Behavior Change: Family Planning Uptake in District Korangi, Karachi
Author: Amber Baloach

This study explores the role of CHWs in driving social behavior change to increase family planning (FP) uptake in District Korangi, Karachi, under TCI. In response to Pakistan’s ongoing efforts to meet Sustainable Development Goal 3, especially universal access to sexual and reproductive health services, TCI introduced HIIs that leveraged CHWs to address low use of modern contraceptive methods in underserved urban areas. A retrospective analysis of secondary data from Korangi health facilities compared FP service uptake before and after CHW engagement, covering January 2022 to April 2023. Results showed a significant rise in the number of FP clients from 25,410 between January and September 2022 to 45,294 by April 2023, demonstrating the effectiveness of CHW engagement in shifting social norms, raising awareness, and increasing demand for and access to FP services. These findings underscore the critical role CHWs play in strengthening reproductive health service delivery in resource-limited urban settings and affirm the value of community-based strategies in advancing national FP goals.

The Missing Link from Family Planning Programs: Barriers and Opportunities for Improving Male Involvement in Family Planning Interventions in Pakistan
Author: Khubaib Kyani, Gender Specialist

This study examines the barriers and opportunities for increasing male involvement in family planning (FP) programs in Pakistan, an essential but often overlooked component of reproductive health. Conducted in Punjab, Sindh, and Islamabad, the study combined direct observation at government health facilities in Islamabad and Faisalabad with qualitative input from key stakeholders, including officials from the Departments of Health (DoH) and Population Welfare (PWD), facility providers, and health workers. Findings revealed widespread reluctance to engage men in FP services, largely due to cultural sensitivities and communication challenges faced by predominantly female health staff. Male clients were often discouraged from entering facilities, even when accompanying female family members, and there were few provisions to support their involvement. When male family welfare assistants were present, they typically engaged with men outside the facility premises. To close these gaps, the study recommends a comprehensive set of strategies: hosting male-focused family health days, incorporating male engagement into staff training curricula, establishing clear guidelines for male involvement, improving provider capacity in gender-sensitive communication, displaying FP materials targeting men, creating a more welcoming environment for male visitors, and launching media campaigns to normalize male participation in FP. These interventions aim to foster more inclusive service delivery and encourage shared responsibility in reproductive health decision-making.

Impact of Quality Implementation (QI) Checklist in Gap Analysis and Sustainability of High Impact Interventions (HIIs/HIPs) of Family Planning, Focusing on Health System Strengthening
Author: Dr. Rabia Roy Aqeel, QA Manager, Sindh

This study assesses the effectiveness of the Quality Implementation (QI) Checklist in identifying service delivery gaps and promoting the sustainability of HIIs within family planning (FP) services, with an emphasis on health system strengthening. Developed by TCI, the QI Checklist was designed to evaluate the quality of FP services at selected public facilities. Initially piloted in 10 facilities in District West, Karachi – focusing on Family Health Days, postpartum family planning (PPFP), and data use for decision-making – the tool was later scaled to 80 facilities across eight districts in Karachi and Hyderabad. The expanded checklist covered additional HIIs, including whole-site orientation, satellite camps, and facility makeovers. It was used for quarterly assessments and helped inform district-specific action plans. The results showed notable improvements, driven by the identification and replication of best practices that had previously been absent in some districts. However, challenges remained, including limited staff capacity, inconsistent adherence to FP guidelines, weak data systems, and poor coordination between departments. The study highlights that sustaining HIIs requires more than infrastructure and technical training. Long-term success depends on systemic improvements – such as enforcing protocols, regular monitoring, and strong managerial oversight – to build a resilient and self-reliant health system.

Successful Use of the ECR Within cLMIS; A Step Towards Data Digitalization in the Sindh Province, Pakistan
Author: Dr. Tahira Sahar, City Manager

The integration of Electronic Case Reporting (ECR) into the Contraceptive Logistics Management Information System (cLMIS) across 200 Family Welfare Centres in Sindh represents a key step forward in the digitalization of family planning (FP) data systems in Pakistan. This qualitative study collected insights from 95 purposively selected healthcare providers and administrators through semi-structured interviews, which were analyzed using thematic analysis. Respondents cited several benefits of ECR, including improved data quality, reduced time spent on data entry, and better record management. However, they also noted challenges such as limited staff familiarity with the system, lack of access to digital devices, poor internet connectivity in remote areas, and initial resistance to adopting new technologies. Despite these challenges, the findings suggest that integrating ECR into cLMIS has strong potential to enhance the efficiency and reliability of FP data management, especially in resource-limited and peri-urban areas. This pilot initiative reflects a promising direction for digital health innovation in low- and middle-income settings and supports further scale-up and investment.