The Challenge Initiative (TCI) supports local governments in East Africa, Francophone West Africa, India, Nigeria, Pakistan and the Philippines to implement high-impact practices (HIPs)  and other interventions (HIIs). HIPs – a set of evidence-based best practices reflecting global expert consensus on what works in family planning programming – are operationalized and adapted for the local context before being included in TCI University. HIPs are scalable, sustainable, and cost-effective interventions designed to improve family planning service delivery, demand generation, and the broader enabling environment. HIIs are TCI’s other interventions that have been proven successful but are specific for certain country contexts.

However, a lack of globally standardized measures for HIPs & HIIs makes it difficult to gather and compare data across countries (Lebrun, 2022). An indicator inventory led by the Data for Impact (D4I) project and Research for Scalable Solutions (R4S)/SMART-HIPs in 2024 showed that while many countries implement HIPs & HIIs, variations exist in the indicators used to measure their effectiveness and their definitions, and data are often disconnected from national databases. Standard measures can help ensure HIPs & HIIs are well implemented across countries and that results are comparable in assessing impact in these different locations.

To support the monitoring of HIPs & HIIs across its more than 200 engaged cities, TCI has developed tools specifically designed to assess progress across three key domains of scale-up: coverage (horizontal scale), institutionalization (vertical scale), and quality implementation. To measure coverage of family planning HIPs & HIIs, TCI’s tools assess the extent and reach of interventions in different areas, which provides valuable insights into how the HIPs & HIIs are being implemented and scaled up. Tracking whether HIPs & HIIs are incorporated into local policies and practices (i.e., institutionalization) can lead to long-term sustainability because integrating these interventions within existing health systems enables local governments to maintain and expand them independently. Finally, the quality implementation domain focuses on consistency and adherence to evidence-based standards, ensuring that family planning practices are delivered effectively. Together, these three domains undergird the sustainable scale-up of each HIP or HII and contribute to the achievement of TCI’s primary goal of increasing the voluntary uptake of modern contraceptive methods.

Figure 1: Three dimensions or domains in the scale up of HIPs & HIIs.

Measuring Coverage (horizontal scale) through TCI’s HII/HIP Records Tool

TCI’s HII/HIP Records tool is designed to measure coverage across health facilities and communities. Key indicators focus on:

• eligible facilities implementing a specific HIP or HII
• providers trained on a specific HIP or HII, with gender disaggregation
• events conducted for a specific HIP or HII, for event-based interventions like outreaches

These indicators are measured for each HIP or HII implemented by local governments and supported by TCI. This includes Community Health Workers (CHWs), immediate postpartum family planning (PPFP), mobile outreach services, pharmacy engagement, dissemination of information through mass media, among others. TCI’s core package of interventions directly align with several HIPs but have been adapted for the local context across TCI’s six hubs. Table 1 is an example that shows the indicators in the HII/HIP Records tool for CHWs and PPFP.

Table 1: HII/HIP Records Tool example showing some coverage indicators

Measuring Institutionalization (vertical scale) through TCI’s HII/HIP Records Tool

In addition, the HII/HIP Records tool also measures the institutionalization of these practices within local government policies, budgets, and work plans. Key indicators focus on:

• HIP or HII incorporated into local policies, costed implementation plans, or guidelines
• HIP or HII incorporated into annual budgeted workplans or operational plans
• HIP or HII budget utilized or other evidence that the intervention was conducted

These are measured for each HIP or HII. As an example, a list of these indicators for CHW and PPFP are listed in Table 2.

Table 2: HIIs/HIPs Record Tool showing some institutionalization indicators

Measuring Quality Implementation through TCI’s QI Checklists

Finally, the quality implementation (QI) of HIPs & HIIs is measured by TCI’s QI Checklists, a list of standards based on global or national guidelines to ensure key parameters are met. There is a list for each intervention that differs by hub depending on the policies and situation at the location. Therefore, the checklist is designed to fit each hub’s context. While checklists may differ across locations, certain core elements are present in all checklists where relevant. These include:

• Trained providers on HIP or HII in the facility/city
• Relevant supplies/materials available in the facility/city
• Regular reporting of data from the facility/city, as expected
• Regular review of data in the facility/city, as expected
• Planning of event-based HIPs or HIIs with key stakeholders

This checklist also allows facilities to identify areas of improvement and lays out clear steps to follow to improve the quality of services provided to populations. Figures 2 and 3 contain examples of checklists for CHWs and PPFP, respectively.

Figure 2: Sample QI Checklist for CHWs from East Africa.

Figure 3: Sample HII/HIP Checklist for Immediate PPFP from Francophone West Africa.

Scope of Measurement

Data collection using these tools is conducted on a regular basis to ensure robust monitoring and timely insights. For TCI’s HII/HIP Records Tool, hub staff gather information from all implementing facilities in all active cities on a quarterly basis. TCI’s QI checklists, in contrast, involve sampling either 10% or a minimum of five facilities, whichever is lower, for each active city. During quarterly site visits, TCI hub staff interview facility personnel, review verification documents, and conduct observations to assess quality implementation.

For those interested in learning more about these tools and TCI’s approach to tracking family planning high-impact practices, please feel free to contact TCI for further details.