The Challenge Initiative: Expanding Access to Family Planning

The Social Challenge

Sustainable Access to Family Planning Information and Services

The United Nations projects that by 2050, nearly 70% of the world’s population will live in cities. Ninety percent of this urban growth is expected to occur in Africa and Asia, primarily in urban slums. Urban poverty, gender equality, human rights, maternal and child mortality and climate change are global challenges that will worsen if urban slums continue to grow at the same rate as today. Investing in voluntary, rights-based family planning to expand access to contraceptive information and services can address these issues in a significant way. Allowing women and their partners to decide on family size and child spacing has measurable positive impact across various aspects of development.

The Partnership

The Challenge Initiative (TCI)

The Partners

• Bayer AG
• The Bill & Melinda Gates Foundation
• The William H. Gates Sr. Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health

The Idea and the Action

The Challenge Initiative (TCI) offers a unique approach to financing, scaling and sustaining family planning programs that are designed to address the rapid urbanization taking place in Africa and Asia. TCI has engaged more than 200 city governments across 13 countries to implement high-impact family planning practices and other interventions to rapidly scale access to contraceptives. When women can plan the number and spacing of their pregnancies, they can plan for a brighter future, whether that includes a career, education or a family.

With the support of Bayer and the Gates Foundation, TCI works through six regional hubs in East Africa, Francophone West Africa, India, Nigeria, Pakistan and the Philippines. TCI’s hubs engage local governments eager to address their family planning issues. To participate in TCI, these sub-national governments must commit their own financial and human resources and political will. Once accepted, they can access TCI’s Challenge Fund, which offers seed money to incentivize participation, and TCI coaching to support their implementation of evidence-based family planning solutions. TCI also coaches local governments in skills such as management and leadership.

TCI strengthens local health systems and workers with customized coaching, tools, and resources so they can design, fund, and lead their own family planning programs. Once TCI’s direct support ends, local leaders take the reins and continue funding and implementing these programs, applying lessons to strengthen health and governance systems. Throughout and following TCI's direct engagement, stakeholders have access to TCI University, a dynamic web-based learning system used to coach local implementers. TCI’s engagement with each city lasts about three years, but its platform allows multiple investors to “buy in” so it can continue adding cities as existing ones “graduate.”

The Impact

Since launching in 2016, TCI has contributed to an additional 4.5 million family planning users in 213 cities across 13 countries – Benin, Burkina Faso, Cote d’Ivoire, Kenya, India, Niger, Nigeria, Pakistan, the Philippines, Senegal, Tanzania, Togo, and Uganda – covering a total population footprint of 244 million. Local governments have committed more than $66 million to finance high-impact family planning services. More than $44 million (67%) of that funding has been spent. This impact and financing continued after TCI’s period of engagement ended in many of the 99 cities that “graduated” from TCI support. TCI also monitors various indicators to measure the effectiveness of its interventions, leadership skills, institutionalization of favorable family planning policies, and government self-reliance.

The Faculty Insight

Experts regard access to family planning services as “the most effective and financially sound ways to save the lives and improve the health of women and children while contributing to the economic and social development of the country.” Despite these widely recognized benefits, access to family planning services remains severely limited in low- and middle-income countries (LMICs). For example, in sub-Saharan Africa, up to 35% of women who want to delay or avert pregnancies do not have access to any form of contraception, a stark contrast to the mere 6% women facing this issue in North America and Western Europe. This shortfall impedes the achievement of United Nations Sustainable Development Goal 3 to “ensure healthy lives and promote well-being for all at all ages” and provide “universal access to sexual and reproductive health-care services.”

Recognizing this issue, The Challenge Initiative (TCI) supports 198 city governments across 13 LMICs to expand the delivery of contraceptives and other family planning services to the urban poor. In collaboration with Bayer AG and The Gates Institute, the partnership uses a comprehensive three-pronged approach encompassing (a) capacity building, (b) financial resource mobilization and (c) sustainable program design to accomplish this goal. A distinguishing feature of this partnership is to leverage the influence of local city governments, leading to sustained improvements in urban health systems and increased use of modern contraception among urban poor. Recent research also attests to the benefits of active government engagement, particularly from women political leaders, in advancing contraceptive access in LMICs.

Recently, there has been an increased push for LMICs to become self-sufficient in meeting their family planning needs, as evidenced by renewed commitments to the Family Planning 2030 global partnership. With foreign funding for supporting family planning programs projected to wane in the coming decade, it is imperative for LMICs to be self-sufficient in designing and implementing their own programs. In light of these global developments, the pioneering work of TCI at the local level serves as a crucial catalyst for empowering countless women in LMICs to take better care of their mental and physical health.

To learn more about Darden Assistant Professor of Business Administration Dwaipayan Roy’s research on whether having more women leaders would improve contraceptive access and more broadly, women’s health outcomes, see here.

The Darden School of Business’ Institute for Business in Society partners with Concordia and the U.S. Department of State Secretary’s Office of Global Partnerships to present the annual P3 Impact Award, which recognizes leading public-private partnerships that improve communities around the world. This year’s award will be presented at the Concordia Annual Summit the week of 23 September 2024. The five finalists will be highlighted on Darden Ideas to Action on Fridays leading up to the event.

This article was developed with the support of Darden’s Institute for Business in Society where Maggie Morse is director of programs.