About TCI and the evaluation
Across cities in Africa and Asia, The Challenge Initiative (TCI) has been testing a bold proposition: that lasting gains in family planning come from strengthening local systems, not short‑term projects.
Launched in 2016 as a ‘business unusual’ platform, The Challenge Initiative (TCI) addresses a critical development challenge: How to sustainably scale up High Impact Interventions (HIIs) and Practices (HIPs) that have been shown to be effective in similar geographies.
TCI is working with 214 local governments across 13 countries. The model focuses on building capacity, promoting local ownership, and helping cities to scale up proven high‑impact practices to expand access to modern contraception for the urban poor.
To understand how well the approach was working, TCI commissioned an independent review by Itad. The evaluation brought together three lines of enquiry – impact, process, and cost efficiency – providing the most comprehensive assessment of the model to date.
The offer clear guidance for policymakers and programme designers seeking scalable, sustainable approaches to urban reproductive health.
Five findings every decision-maker should know
- TCI’s work, alongside existing family planning provision, increased contraceptive uptake. In 40 TCI-supported cities, the evaluation found moderate to strong evidence of increased contraceptive uptake due to TCI. Across these local governments Net Contraceptive Uptake (NCU) increased by 1.52 per 1000 women of reproductive age on average each month; and these gains in NCU were attributed directly to TCI in 60% of local governments evaluated. This translates to an estimated 633,056 additional family planning clients generated over the course of TCI’s support. The study also highlighted the potential of using Health Management Information System (HMIS) data for impact evaluation when supported by rigorous data cleaning and context sensitive analysis (see Itad’s recent blog).
- TCI’s model effectively pays for itself.
Itad’s cost-efficiency analysis found that TCI generated more savings for local governments due to reduced expenditures on education and health care than its total expenditure. With programme spending of $41.45 million in the 40 cities studied, the initiative delivered an estimated $50.2 million in cost savings, with every region demonstrating a positive return on investment. For budget-constrained governments and donors, the message is clear: strengthening local systems is both impactful and cost‑saving. - Local ownership is laying the groundwork for sustainability.
Itad’s process evaluation showed that high-impact practices have continued in cities that graduated from TCI support. TCI’s master coach model – which embeds coaching systems within local structures to bring about long-term, sustainable transformation in family planning delivery – was seen by stakeholders as being particularly valuable. Stakeholders widely appreciated TCI’s emphasis on local ownership, continuous capacity-building, and data-driven decision-making for long-term programme resilience. - Context determines both impact and sustainability.
The evaluation underscored the role of wider health system factors in shaping outcomes. Financial constraints, leadership changes, health workforce turnover and commodity shortages all affected local capacity to sustain gains. 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. - Locally led, system‑focused models work, but require strong health systems to thrive.
TCI’s experience demonstrates that investing in local capacity yields measurable results and value for money. But the evaluation stresses that sustainable progress depends on tackling persistent systemic bottlenecks, particularly supply chain management, financing and workforce stability. For decision-makers, the evidence provides a clear blueprint for scaling family planning programmes that deliver impact, efficiency and resilience.
A model with momentum
Overall, the evaluation affirms that TCI’s ‘business‑unusual’ model is achieving results at scale. It offers the clearest evidence yet of how locally led capacity strengthening can drive contraceptive uptake, shape resilient local health systems, and deliver value for money. As participating local governments transition to greater self-reliance and look to further expand access to urban family planning services, the challenge now is sustaining these gains, turning early success into long‑term, system‑wide improvements.
