Reviewing the data used for decision-making in Meerut, Uttar Pradesh.

Cities in India that no longer receive direct support from The Challenge Initiative (TCI) are gradually becoming favorite destinations for state officials that want to learn how family planning and other health services are provided in urban settings. These cities have reached TCI’s “graduation” milestone, which occurs after about 3.5 years and indicates the resilience, maturity, and ability to sustain family planning and adolescent and youth sexual and reproductive health (AYSRH) high-impact practices and other interventions without dedicated support from TCI. Cities in Uttar Pradesh have continued to perform well, post graduation from TCI.

Director of Family Welfare, Dr Neelambar, and Joint Director Mr. Amit Singh visited two urban primary health centers (UPHCs) in Meerut, Uttar Pradesh, on June 1, 2023, to observe a Fixed-Day Static Services (FDS) intervention. They also witnessed an increase in client traffic, while reviewing data dashboards with extreme interest to learn how they aid in decision-making at all levels of stakeholders. They expressed appreciation for the facility staff and the District National Urban Health Mission (NUHM) team for their efforts in providing quality services and keeping updated records. TCI master coaches, including other city officials, facilitated the entire visit.

When it graduated from TCI in August 2022, Meerut had recorded 33,890 additional family planning users. In March 2023, seven months after graduating, additional users in Meerut rose to 43,354.

Additional user trend continues to rise in Meerut post-graduation.

Meerut’s story is not the only example of the sustainability of family planning and AYSRH programs after TCI support ends. Similar results and gains are being seen in 19 other Uttar Pradesh cities that graduated from TCI. These gains are the result of TCI’s approach, including its innovative coaching model where TCI begins coaching cities at a high intensity that declines as cities near graduation. TCI also trains master coaches within the local health system during the period of direct engagement.

These master coaches are considered game-changers for sustainability because they continue to strengthen the capacity of other coaches within the city, influencing the adoption of high-impact practices and other interventions in nearby towns. They also can bridge gaps between different departments to ensure no duplication of efforts and they continue advocating for family planning resources to not only be earmarked, but also actually be spent on family planning activities.

In addition, TCI has found that 94% of the facilities across graduated cities still conduct FDS four times a month. FDS is a key indicator of sustainability for TCI in India because it signifies that quality family planning services continue to be utilized by the urban poor after the city graduated from TCI.

TCI’s low-touch support in India has also ensured that the rigor is maintained in review meetings such as those held to conduct Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) self-assessments. The following report details TCI’s experience in Uttar Pradesh with 20 graduated cities.