Urban poor people survive in the ambiguity of bright, shining lights under poor living conditions in posh localities. Given the rapid increase in the number of people living in urban poor settings; understanding and responding to their family planning and reproductive health needs is critical. In devising the path ahead, attention must be focused on scaling up strategies that have demonstrated results and meet the needs of this segment of the population. 
The Challenge Initiative for Healthy Cities (TCIHC) is a platform, which consolidates proven high impact approaches related to family planning and scales them in cities requiring them the most by getting the city administration to take charge of the change they want to see in the city. TCIHC is a “business unusual” approach, which activates existing service delivery platforms to serve the urban poor with quality family planning services.
Thus more than ever, if there ever was a need for a reimagined response, then it is now!
The state governments in Madhya Pradesh (MP), Odisha, Uttar Pradesh (UP), have officially endorsed nine of TCIHC proven approaches that are being used to successfully implement family planning activities in eight MP cities, three Odisha cities and 20 UP cities. This indicates that TCIHC’s approaches are now available for use in all cities throughout all its intervention states.
City Activation and Rise in Family Planning Acceptors
Now, it takes TCIHC only 45 days to activate a new city for family planning services at the urban primary health centre level. This formula is codified and available on TCI U. Meanwhile, the rise in family planning acceptors at the urban primary health centre in TCIHC cities is up by over 0.13 million cases and this has contributed to the city-level performance, which has witnessed an additional 0.15 million cases than the previous year (source: HMIS).
The first phase of USAID’s grant through its global Maternal and Child-Survival Program ended on September 30, 2019.  In this partnership, TCIHC demonstrated a promising referral mechanism for family planning and ‘maternal and newborn health’ (MNH) services in three demonstration cities in Madhya Pradesh and Odisha. Other MNH approaches of UPHC readiness assessment and integrated pediatric unit have also received a favourable response from both the state governments.
TCIHC with the help of its high impact approach, Listing and mapping of slums and Vulnerable population has made 1700 invisible areas visible to the city authorities, which houses more than 238% urban poor population. 
Interesting data analysis revealed that more than 44% of all women voluntarily accessing the fixed day static services for an intrauterine contraceptive device or injectable contraceptive were 15-24 years of age.
Inequitable gender and cultural norms around fertility and provider bias leads many young married mothers in UP and elsewhere to have closely spaced pregnancies that compromise their health. Read how TCIHC helped accelerate family planning services for Allahabad's first-time parents. 
“Scaling up TCIHC ‘s approaches, particularly FDS, across the state of Odisha will help so many more women and girls access quality family planning services,” said Dr. Anuradha Jain, USAID/India’s Project Management Specialist (Urban Health). Read more on TCI University.

TCIHC has demonstrated a demand for methods other than oral pills, condoms and sterilization. It has infact reversed the trend for spacing methods, which can be better understood if one looks at these numbers. In Sept.2017, the HMIS data showed that over 57000 clients had accepted a spacing method and by Jan.2018 it had reduced to 45000 clients voluntarily choosing a spacing method of their choice. By this time, TCIHC had started making strong inroads into the cities with govt. support and had started intensive work on expanding the basket of choice of family planning methods. As a result, by Jan. 2019 over 66000 clients had accepted a spacing method and by June 2019 over 91000 clients had accepted a spacing method of their choice. Had it not been a joint effort of the city government and TCIHC, the demand for spacing methods and short term methods would have touched even low.

- Gates Institute's Kojo Lokko, Director-TCI and Jennifer Guertin, Associate Director-TCI, visited TCIHC India from Dec.9 to Dec.13, 2019 to discuss the new TCIHC strategy and identify areas of collaboration in new investment.

- PSI Global's Judi Heichelheim, Chief Operation Officer and Barry Whittle, Vice President for Accelerating Market group visited TCIHC cities of Firozabad and Agra to understand TCIHC program.
- Ms. Chhavi Bhardwaj, IAS, MD, NHM, Madhya Pradesh accepted TCIHCs recommendation for the introduction of a new cadre of Public Health Manager in the cities. The PHM is expected to take a role similar to the FPA/FPC cadre as successfully demonstrated by TCIHC.
Starting from this series, we will feature our TCIHC city teams who have advanced into their respective cities and the family planning circle. 

About TCIHC!
TCIHC builds on the demonstrated success of the Bill & Melinda Gates Foundation’s 'Urban Reproductive Health Initiative', 'Expand Access and Quality to broaden method choice' and USAID’s 'Health of the Urban Poor'.  It is scaling up these proven solutions for family planning for the urban poor population. It is an unusual approach for providing life-saving reproductive health and family planning information and services to individuals, families and communities.

Mukesh Sharma, Chief of Party | Hitesh Sahni, Associate Director | Devika Varghese, Associate Director | Emily Das, Associate Director, MLE | Deepti Mathur, Senior Specialist, KM | Parul Saxena, Manager, Documentation | Raj Rishi Mitra, Manager, TCIHC | Gunjan Razdan, Manager, TCIHC

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