A Platform for Sustainable Scale: The Challenge Initiative's Innovative Approach to Scaling Proven Interventions

Abstract

Introduction: The global health community continues to face barriers in scaling up evidence-based interventions for widespread adoption. Although many effective interventions have been developed over the years, expanding their reach to benefit broader populations has happened slowly or not at all.

Overview: The Challenge Initiative (TCI) is a nontraditional development platform that supports local urban governments to rapidly scale up proven family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) interventions for the urban poor. TCI prioritizes sustainability and local ownership and uses a health systems approach when planning for and managing scale. TCI strengthens urban health systems with seed funding, coaching, and technical assistance (TA), and TCI University houses "how-to" guidance and tools for implementing the interventions. In turn, local governments commit political will and financial and human resources while using TCI coaching to integrate interventions into routine practice and systems to achieve widespread and sustained impact at scale.

Results: As of June 2021, TCI has supported 104 local governments across 11 countries in scaling up effective FP and AYSRH interventions, while also mobilizing about US$28 million from those local governments to facilitate their implementation. TCI has increased capacity and bolstered urban health systems, with 39 local governments "graduating" from TCI support and 2.02 million additional FP clients across 4 regional TA hubs.

Conclusion: TCI aims to change how local governments coordinate, finance, and implement proven interventions to improve access to quality FP information and services. With built-in incentives for local governments, partners, and donors to participate, TCI is generating significant learning on how local governments can realize sustainable scale and demonstrating how organizations like TCI that facilitate governments to scale up effective interventions can accelerate the scale-up of these interventions across multiple geographies.

FIGURE 1

The Challenge Initiative Scaling Over Time, 2017–2021, by Population and Number of Cities^a Abbreviations: EA, East Africa; FWA, francophone West Africa; TCI, The Challenge Initiative. ^a The cumulative number of cities is indicated by the line. Population footprint by hub.

FIGURE 2

Pre- and Postgraduation Trends in Additional Family Planning Clients in 5 East African Cities

FIGURE 3

An Average of Graduated Cities' RAISE Scores in 6 Countries Over Time^a Abbreviation: RAISE, Reflection and Action to Improve Self-Reliance and Effectiveness. ^a The last 1 or 2 rounds occurred postgraduation in India, Kenya, Nigeria, Tanzania, and Uganda. Senegal’s graduated cities had not yet conducted post-graduation RAISE assessments.

FIGURE 4

Local Commitments, Local Spending, and the Challenge Fund Allocations Across TCI Hubs (Years 2–4), in USD Abbreviations: TCI, The Challenge Initiative; USD, U.S. dollars.