The TCI Model Works: New Evidence Shows How to Scale Family Planning That Lasts

What does it take to scale family planning programs that actually last?

A new independent evaluation of The Challenge Initiative (TCI) offers a compelling answer: invest in local systems and let governments lead.

The evaluation, conducted by Itad, finds that TCI, a platform of the William H. Gates Sr. Institute for Population and Reproductive Health (WHGI), is delivering measurable results across urban areas in Africa and Asia. From increased contraceptive uptake to cost savings for governments, the evidence points to a model that is both effective and sustainable.

At a time when global health funding is tightening and the pressure to deliver impact is growing, these findings matter.

A Shift Away from “Business as Usual”

For too long, family planning programs have relied on short-term, externally driven projects that struggle to sustain gains once funding ends.

TCI was designed to challenge that model.

Since 2016, TCI has partnered with more than 200 local governments across 13 countries to scale proven, evidence-based family planning approaches. Instead of funding service delivery, TCI strengthens local capacity, builds government ownership, and embeds coaching systems that enable cities to lead and sustain their own progress.

This is what TCI calls a “business unusual” approach.

Now, we have the evidence to show it works.

Five Key Findings of the TCI Evaluation

The evaluation delivers a clear message for governments, donors, and implementers: scaling impact and sustainability is possible, but only if we invest differently.

1. It increases contraceptive uptake at scale

Across 40 cities, TCI contributed to measurable increases in contraceptive use, reaching an estimated 633,056 additional clients. These are not small pilot gains. They reflect impact across diverse, real-world settings.

2. It saves money

TCI generated more in savings than it cost to implement, with $50.2 million in savings compared to $41.45 million in program costs. In resource-constrained environments, this is not just a success story. It is a strong case for policy change.

3. It builds systems that are locally owned and sustainable

Cities are continuing family planning programs after graduating from TCI support. This is because the model invests in local ownership, coaching, and institutional capacity rather than dependency. Read more about TCI’s master coach model, which was seen as particularly valuables for program resilience.

4. It reveals what’s holding systems back

The evaluation does more than highlight success. It points directly to the barriers that remain. Supply chain failures, workforce instability, and financing gaps continue to limit progress.  For example, in Côte d’Ivoire, supply chain collapse directly undermined contraceptive uptake, even with concurrent TCI and partners’ support, highlighting supply challenges as a critical barrier.

5. It proves locally led, system-focused models can deliver – but need strong health systems to thrive.

Local systems can lead effectively when they are properly supported. The findings make it clear that strong outcomes depend on sustained investment and attention to systemic bottlenecks, particularly supply chain management, financing, and workforce stability. For decision-makers, the evidence provides a clear blueprint for scaling family planning program that deliver impact, efficiency, and resilience.

The Bigger Message: Stop Funding Projects. Start Funding Systems.

Healthcare worker being coached using TCI’s master coaching model

For donors and policymakers, the implication is clear. If we want durable impact, we need to invest in approaches that build local ownership, strengthen institutions, and work within real-world systems.

From Evidence to Action: What We Heard in the Webinar

To unpack these findings, WHGI and Itad convened a global audience of researchers, implementers, donors, and government leaders on February 26, 2026.

The conversation focused on a key question: what does it actually take to scale and sustain family planning programs in complex environments?

Key reflections included:

• • We can measure impact at scale. With proper validation, routine HMIS data can be a powerful and cost-effective tool for evaluation.
  • Value for money must be realistic. This evaluation took a conservative approach, offering credible insights for decision-makers.
  • Sustainability requires leadership and strong systems. Coaching, partnerships, and government stewardship are essential.
  • Context matters. Programs must adapt to local realities, including shocks like COVID-19 and ongoing system constraints.

Participants also raised important questions about how these lessons can be applied in different settings, highlighting strong global interest in models that move beyond pilot success to sustained scale.

Sustaining the Momentum

The evidence is strong. Overall, the evaluation affirms that TCI’s “business-unusual” approach is achieving results at scale.

If we are serious about expanding access to family planning, especially for underserved urban populations, we need to move beyond business as usual.

That means:

• • Investing in local systems, not parallel ones
  • Prioritizing government leadership and accountability
  • Addressing persistent system bottlenecks
  • Scaling what works while adapting to context

Explore the Resources from the TCI Evaluation

Ready to learn more?

• • Read this webinar recap blog and watch the full webinar
  • Read the webinar Q&A
  • Access the evaluation executive summary
  • Read Itad’s blog