Scaling Access to Contraception for Youth in Urban Slums: The Challenge Initiative's Systems-Based Multi-Pronged Strategy for Youth-Friendly Cities

Abstract

Introduction: More than half of all adolescents globally live in Asia, with India having the largest adolescent population in the world at 253 million. In sub-Saharan Africa, adolescents make up the greatest proportion of the population, with 23% of the population aged 10–19. And these numbers are predicted to grow rapidly—particularly in urban areas as rural youth migrate to cities for economic opportunities. While adolescents and youth are subject to high sexual and reproductive health risks, few efforts have been documented for addressing these in urban settings, especially in poor settlements.Methods: The Challenge Initiative (TCI) is a demand-driven, family planning platform for sustainable scale and impact that lets city governments—in particular urban slums—lead implementation. It is currently active in 11 countries in Africa and Asia. In June 2018, TCI heightened its focus on adolescent and youth sexual and reproductive health (AYSRH) for youth living in urban slums. It now supports 39 city governments. TCI dedicates technical and program support to married (including first-time parents) and unmarried youth ages 15–24 years. Using an innovative coaching model and an online learning platform (TCI University), TCI supports city governments as they implement AYSRH interventions to accelerate the impact of TCI's model for rapid scale.Results: TCI has been assessing the performance of cities implementing its AYSRH approaches using its RAISE tool and has found considerable improvement over two rounds of assessments through TCI coaching and support for adaptation of its high-impact interventions between the first and second round.Conclusions: TCI's AYSRH approach scaled rapidly to 39 cities and multiple urban slums since 2018, using its evidence-based interventions and coaching model. In the context of universal health coverage, TCI has supported segmented demand generation and improved access to quality and affordable contraceptive as well as youth-friendly health services. It provides a menu of interventions for cities to implement for youth—including such approaches as public-private partnerships with pharmacies and quality assurance using quick checklists—along with an innovative coaching model. This approach has facilitated greater access to contraceptive methods of choice for youth.

Integrated Theory-Based Health and Development Interventions for Young People: A Global Scoping Review

“…Multilevel theories, such as the socioecological model, which address levels beyond the individual young person, should also be considered. While this assumes theory-based interventions are better, some programs that encompass a more iterative or quality improvement approach or that are developed in conjunction with youth or other community members may also have positive outcomes (Bose et al, 2021; Fakoya et al, 2021). Further research is needed to assess distinctions and outcomes of interventions using specific theories, such as the review of programs using PYD (Gavin et al, 2010).…”

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

“…TCI-U also includes AYSRH interventions to address provider bias, promote youth-friendly cities, engage pharmacies and drug shops, and use other approaches that enable younger women and men to access contraceptives. 27 In addition to technical (intervention-focused) coaching on FP and AYSRH interventions, TCI provides coaching assistance to strengthen a local government's leadership, management, and coordination functions, financial management and monitoring, adaptation of interventions, and data for decision making-what TCI refers to as "essentials" for successful programming. These essentials have become an increasingly prominent focus of coaching support, based on learnings that coaching at higher levels of the health system-such as state, city, and local government area administrative levels rather than only at the facility/provider level-is required to ensure sufficient capacity to scale and potential to sustain systems level capability to maintain quality FP programming.…”

“…By the third quarter, local governments typically assume full leadership of the RAISE workshops to monitor their progress. 27 Through June 2021, 39 governments have graduated from full TCI support. TCI is monitoring the performance of the graduated cities by continuing to track RAISE scores and contraceptive uptake, which will inform refinements to its coaching approach and time frames of support.…”

Socio-economic inequalities in non-use of modern contraceptives among young and non-young married women in India

“…Evidence suggests that youth faces high sexual and reproductive health risks and their age group is an important social determinant of health [ 7 , 24 ]. A study comparing contraceptive use in adolescent girls (ages 15–19 years) and adult women (ages 20–34) in 103 low- and middle-income countries between 2000 and 2017 found that adolescent girls continue to fall behind adult women in contraceptive use [ 25 ].…”