The geographic reach of TCI’s family planning initiatives across 15 major cities in Pakistan.

The Challenge Initiative (TCI) has partnered with city governments across Pakistan to scale up high-impact practices and other interventions (HIPs & HIIs) in marginalized, under-resourced urban communities across 15 densely populated cities.

In Pakistan, district governments (LGs) are responsible for implementing family planning strategies under the guidance of provincial departments. Two key government entities – the Department of Health and the Population Welfare Department – lead the delivery of these services nationwide.

TCI’s initiatives in Pakistan span 15 major cities, reaching a total population of 65 million people (28% of the country’s population). The map highlights key intervention areas, including:

• Sindh: 22.3 million
• Punjab: 39.8million
• Islamabad Capital Territory (ICT): 2.44 million

This expansion has been driven by the implementation of HIIs, strengthening service delivery, and improving access to family planning services. By bridging gaps in urban healthcare, TCI has ensured broader availability of essential services, resulting in a significant increase in family planning users, clearly reflecting the program’s success.

Dr. Aneela Noor, Deputy District Health Officer of District East, highlighted the program’s operational impact:

The contraceptive prevalence rate (CPR) in my district is 31%, and it continues to rise daily. The impact of high-impact interventions (HIIs) – such as the Whole-Site Orientation (WSO) – has been instrumental in increasing client inflow for family planning services. Additionally, the TCI team has played a vital role in reviving our monthly meetings, which are crucial for tracking service delivery and monitoring staff performance.”

TCI’s Reach & Commitment

Since launching in Pakistan in 2022, TCI has focused on the 15 most populous districts, ensuring that HIIs are institutionalized for long-term sustainability. Despite challenges such as political instability and economic constraints, the initiative continues to strengthen family planning programs through rapid implementation, improved service delivery, and capacity-building.

Working in government-selected districts across Punjab, Sindh, and the Islamabad Capital Territory, TCI collaborates with local leadership to prioritize and embed these interventions into national and provincial policies, budgets, and operational plans.

Scaling High-Impact Interventions

Local governments have prioritized several HIIs, including:

• Capacity building of Community Health Workers

• Family Health Days to increase service outreach

• Mobile service delivery through Mobile Service Units and Satellite Camps

• Whole Site Orientation (WSO) for improved facility readiness

• Facility Makeovers to enhance service environments

• Advocacy with Family Planning Champions

• Postpartum (PPFP) and Post-Abortion Family Planning (PAFP) services

• Mass Media Campaigns to increase awareness

As of 2024, over 80% of these prioritized interventions have been successfully scaled up.

Dr. Shereen Sukhun, District Population Officer of Rawalpindi, shares her appreciation of TCI’s support in the district.

Dr. Shereen Sukhun, District Population Officer of Rawalpindi, emphasized TCI’s role in expanding access:

Government budgets are constrained, making it difficult to reach communities in remote areas. With the support of TCI-Pakistan, we have expanded services through satellite camps and mobile service units, which have significantly increased the number of additional family planning users. Secondly, the engagement of mosque Imams has played a crucial role in dispelling myths and misconceptions about family planning. Their support has been instrumental in scaling up the program in our district. In our context, where religious leaders hold great influence, Imams can play a pivotal role in counseling families and husbands, making this model highly effective.”

Rapid Growth in Family Planning Service Uptake

With strong government support, the successful execution of HIIs has significantly increased the number of family planning users. Local government leadership acknowledges TCI’s role in introducing and revitalizing these interventions, many of which were already part of government policies. The number of family planning users has grown remarkably, from 7,181 in mid-2022 to 326,469.

Local leadership acknowledges TCI’s role in introducing and revitalizing these interventions, many of which were already part of government policies. With strong support from these governments, the successful execution of HIPs and HIIs has led to a dramatic increase in the number of family planning users, rising from just 7,181 in early 2022 to 326,469 by the end of 2024. This growth includes:

• 2022: 1680.98% increase
• 2023: 40.30% increase
• 2024: 37.52% increase

TCI remains committed to sustaining and expanding the reach of high-impact interventions to ensure more families can access essential family planning services. By embedding these efforts into government systems and structures, the initiative is not only scaling impact but also laying the groundwork for long-term sustainability.

The substantial growth in additional family planning users in targeted districts underscores the effectiveness of TCI’s interventions.