MEETING THE CHALLENGES IN URBAN GLOBAL HEALTH

 

The Challenge Initiative

An exciting “business unusual” approach to financing, scaling up and sustaining high-impact family planning solutions for the urban poor

The Challenge Initiative (TCI) is a global platform that supports local governments in urban areas to scale up high-impact interventions that have been proven successful. By working through existing government and community systems and institutionalizing these practices, TCI facilitates self-reliance and sustainability, while achieving impact.

TCI’s current work focuses on family planning and adolescent and youth sexual and reproductive health (AYSRH) programming, but the TCI model could be applied to any health area related to maternal, newborn and child health. Led by the Bill & Melinda Gates Institute for Population and Reproductive Health (based at Johns Hopkins Bloomberg School of Public Health), TCI has six regional partners or “hubs” in East Africa, Francophone West Africa, India, Nigeria, Pakistan and the Philippines. Those partners are, respectively, Jhpiego, IntraHealth International, Population Services International India, Johns Hopkins Center for Communication Programs, Greenstar Social Marketing and the Zuellig Family Foundation.

 

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TCI has engaged more than 100 local governments in urban areas across 12 countries: Benin, Burkina Faso, Côte d’Ivoire, India, Niger, Kenya, Nigeria, Pakistan, Philippines, Senegal, Tanzania and Uganda. It focuses on urban areas, particularly poor settlements/slums, because the world’s population is increasingly urban. The United Nations predicts that by 2050, nearly 70% of the world’s population will live in cities. And 90% of that growth is expected in Africa and Asia, primarily in poor urban settlements.

TCI’s overall goal is to support the greater self-reliance of local governments to scale up family planning and AYSRH high-impact interventions, leading to sustained improvements in urban health systems and increased use of modern contraception, especially among the urban poor.

Launched in 2016, The Challenge Initiative (TCI) supports local governments in sustainably scaling up high-impact interventions in urban slums.

TCI supports local governments in leading – and owning – their family planning and AYSRH programs by strengthening their capacity and self-reliance. TCI does not implement programs. Under TCI, cities self-select to be part of the team, demonstrate their commitment by bringing their own resources to the table and then lead the implementation of high-impact interventions. In return, local governments can access the Challenge Fund and technical coaching to support the implementation of high-impact interventions that are packaged into easy-to-use toolkits with implementation guidance on TCI University, an online learning experience that serves as TCI’s key mechanism for scale

Once a program is up and running, TCI monitors a number of family planning and contraceptive use indicators while conducting regular quarterly assessments using a TCI tool called RAISE (Reflection and Action to Improve Self-Reliance and Effectiveness) to track capacity and health systems strengthening indicators.

The period of direct engagement with a local government is usually about three and a half years. As the end of direct engagement nears, TCI coaching and Challenge Fund support declines as a local government prepares for “graduation.” Once graduated, the local government is on the path to self-reliance while still having access to TCI University and coaching on demand while TCI continues to monitor for sustained impact.