On February 26, 2026, the William H. Gates Sr. Institute for Population and Reproductive Health and Itad hosted a joint webinar to share findings from Itad’s independent evaluation of The Challenge Initiative (TCI) platform for scaling family planning programs. The evaluation examined TCI’s impact, sustainability, and value across multiple countries and cities, drawing on impact evaluation, process evaluation, and cost-benefit analysis.
The webinar brought together researchers, implementers, donors, and government partners interested in understanding what it takes to deliver family planning programs at scale while strengthening local ownership. Speakers included members of the evaluation team as well as leaders from TCI, who reflected on what the findings mean for future programming.
A Platform Designed for Scale and Sustainability
Led by the Gates Institute, TCI supports subnational governments to implement and scale evidence-based family planning interventions. Rather than directly funding service delivery, TCI focuses on building local capacity and strengthening government stewardship so cities can sustain programs using their own resources.
Over the past decade, TCI has worked with more than 200 local governments across Africa and Asia, supporting them to adopt high-impact practices such as postpartum family planning, community outreach, youth-friendly services, and demand generation approaches tailored to urban populations.
The independent evaluation aimed to assess whether this “business unusual” model is delivering results and whether those results are sustainable over time.
Evidence of Impact
Using health management information system (HMIS) data and Interrupted Time Series analysis, the evaluation found moderate to strong evidence that TCI contributed to increases in contraceptive uptake across supported cities.
At the same time, the evaluation highlighted that performance varied across countries and hubs due to factors such as supply disruptions, differences in method mix, private sector dynamics, and external shocks including COVID-19.
Importantly, the evaluation also demonstrated that routine HMIS data—when carefully validated and analyzed—can be used to assess program impact at scale. This has significant implications for the cost and feasibility of evaluating large health programs in the future.
Understanding Value for Money
The cost-benefit analysis found positive rates of return on TCI’s investments. The evaluation deliberately used a conservative approach, focusing on a limited set of shorter-term benefits such as improved maternal health outcomes and increased access to education and preventive services for children.
Because the analysis also included the full program costs associated with TCI’s model—including coaching, systems strengthening, and capacity building—the estimated returns were lower than some global projections but provide a more realistic estimate of near-term program value.
Strengthening Systems for Long-Term Sustainability
A central question for the evaluation was whether TCI’s locally led model can sustain results after external support ends.
The findings suggest that TCI’s emphasis on government ownership, coaching, and institutionalization within primary health care systems plays an important role in supporting sustainability. In graduated cities, local governments continue implementing family planning interventions using their own resources, while TCI provides ongoing technical guidance and advocacy support.
The process evaluation also highlighted the importance of leadership, strong partnerships, and effective data systems in sustaining progress.
Questions from the Webinar Audience
During the webinar, participants raised a number of thoughtful questions about the evaluation methods, findings, and implications for family planning programs. While we addressed several questions during the session, time ran out before we could respond to all of them live.
▶ See questions and answers from the webinar
Watch the webinar recording:
Hear French translation:
