In this field note, Dr. Anthony Faraon, Chief of Party of The Challenge Initiative (TCI)-Philippines at Zuellig Family Foundation (ZFF), reflects on Bangladesh’s family planning success and the need to adapt as progress plateaus. Observing a TCI workshop in Dhaka, he notes that sustaining gains now requires stronger urban governance, local ownership, and coordination—shifts he saw emerging among city leaders, with lessons drawn from the Philippines’ experience.

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Bangladesh has long been recognized as one of the world’s family planning (FP) success stories. Despite many social and economic challenges, the country achieved impressive gains in contraceptive use and fertility reduction through strong national leadership, an extensive community based workforce, and consistent support from government and development partners.

After spending a week in Dhaka supporting The Challenge Initiative (TCI) Bangladesh’s first Master Training of Trainers (MTOT), I came away with a deeper appreciation of how health systems must continue to evolve. Bangladesh has built a solid foundation in FP, but like many countries, it is now facing a different set of challenges. The question is no longer simply how to increase access to services, but how to sustain progress in rapidly growing cities.

Related articles:

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• TCI-Philippines Draws Lessons from Indonesia’s Family Planning Landscape

What struck me most was not the technical discussions on FP, but how the health system is organized.

Compared with the Philippines, Bangladesh has a different way of delivering urban health services. Responsibilities are shared among several national ministries, city corporations, specialized agencies, and a large number of non-government organizations (NGOs). Together they have built a system that has delivered results for many years. At the same time, this arrangement also means that improving services depends not only on good technical interventions but also on strong coordination among many different actors.

In many ways, Bangladesh was once the poster country for FP. Today, however, it appears to be entering a new phase where earlier gains have started to level off. This does not diminish what the country has accomplished. Rather, it suggests that the strategies which worked well in the past may now need to be complemented by approaches that strengthen urban governance, local ownership, and health system performance.

Throughout the workshop, three topics kept coming up during discussions and group work: data, leadership, and financing. These themes reflected many of the issues identified in the baseline assessment. While facilities continue to serve large numbers of clients, most clients still use short acting methods. NGOs continue to provide a significant share of urban FP services. Gaps also remain in counselling, facility infrastructure, and provider capacity. These findings suggest that improving FP is no longer just about increasing service volume. It is about improving quality, expanding method choice, strengthening systems, and helping cities use data to guide decisions.

One observation stayed with me throughout the workshop.

The MTOT brought together the leadership of the Dhaka South City Corporation. During the different workshop exercises, I saw how discussions gradually shifted from identifying problems to recognizing the city’s own role in addressing them. There was a noticeable sense of ownership developing as participants discussed what they themselves could do moving forward.

Photo above: City leaders and TCI facilitators gather in Dhaka, representing the collaborative network sustaining Bangladesh’s urban family planning gains.

Another reflection relates to the role of NGOs.

Bangladesh’s FP achievements would not have been possible without them. NGOs have expanded access, introduced new approaches, and reached communities that government services alone may not have been able to serve. Their contribution remains one of the country’s greatest strengths. Looking ahead, however, there may be an opportunity to continue strengthening public institutions so that government and NGOs work side by side as partners, rather than having public services depend heavily on external support. This is not about reducing the role of NGOs. It is about building a system where both sectors continue to complement one another in a sustainable way.

This is where I saw an interesting comparison with the Philippines.

Over the years, the Philippine health system has gradually strengthened local government ownership, planning, financing, and accountability. Bangladesh, on the other hand, has shown how partnerships with NGOs can significantly expand reach and service delivery. Neither approach is better than the other because each reflects its own history and context. Instead, both countries have something to learn from one another. The Philippines can continue improving how it works with NGOs as long term implementation partners. Bangladesh may find opportunities to further strengthen city leadership, local financing, and institutional ownership of urban health services.

Perhaps my biggest takeaway was that sustaining success often requires different solutions from those that created the success in the first place.

Bangladesh’s earlier achievements were built on strategies that responded well to the country’s needs at that time. As cities grow and health systems evolve, the next phase may require renewed attention to governance, financing, coordination, and the use of data. It is less about introducing entirely new programs and more about helping existing institutions work better together and strengthening the capacity of cities to lead improvements themselves.

As I left Dhaka, I was reminded that health systems strengthening is not only about better policies or better technologies. It is also about helping institutions work together, building local ownership, and creating conditions where improvements can continue long after projects have ended.

Bangladesh has already shown the world what is possible through sustained investment in family planning. The next chapter may be about helping cities build on that foundation and take greater ownership of the gains they have worked so hard to achieve.

If the discussions and commitment I witnessed during the MTOT are any indication, that next chapter is already beginning.

Author: Dr. Anthony Faraon, ZFF TCI-Philippines Chief of Party

A recent learning visit to Mandaue City provided an opportunity to showcase how local governments can strengthen health systems to improve outcomes for women, adolescents, and families. Originally envisioned as a site visit focused on maternal and child health, the discussions quickly expanded into a broader conversation on governance, leadership, financing, service delivery, and sustainability.

The visit included discussions with the City Health Office and members of the city core group, followed by a field visit to Barangay Cabancalan. Together, these engagements offered a practical demonstration of how local governments can move beyond implementing isolated health activities and instead build systems that enable sustained improvements in health outcomes.

Related articles:

• Mandaue City’s Path Toward Sustainable Family Planning and Adolescent Health
• Mandaue City Redefines Reproductive Care through Women’s Health Caravan

One theme emerged consistently throughout the discussions: transformation begins when local governments own both the problem and the solution.

City officials reflected on how their partnership with the Zuellig Family Foundation through The Challenge Initiative (TCI)-Philippines differed from traditional development assistance. Rather than introducing a predefined package of interventions, the approach focused on helping the city understand its own challenges, strengthen local capacities, and design solutions that fit its unique context. Family planning (FP) and adolescent and youth sexual reproductive health (AYSRH) served as entry points, but the broader objective was strengthening the systems that support health service delivery.

Among the most significant changes cited by city leaders was the establishment of the City Leadership Team. By bringing together representatives from health, education, social welfare, youth development, and barangay governments, the city created a platform for collective problem solving and shared accountability. Health challenges that were once viewed as the responsibility of a single office became shared concerns across sectors.

The city also highlighted the value of leadership development in enabling systems change. Stakeholders described how leadership approaches centered on stakeholder engagement, root cause analysis, and collaborative action helped build confidence in addressing complex and often sensitive issues such as FP and AYSRH.

Another recurring theme was accessibility.

The Women’s Health Caravan demonstrated how health services can be brought closer to communities rather than expecting clients to navigate barriers related to transportation cost, convenience, and stigma. What began as a family planning initiative has evolved into a more comprehensive platform delivering maternal health, AYSRH, human immunodeficiency virus and other sexually transmitted infection services, mental health support, and cancer screening. The model reflects an understanding that community needs rarely fit neatly into a single program area.

The discussions also highlighted how systems strengthening can directly improve access to services. Prior to the city’s engagement with TCI, FP services requiring specialized providers were available only at limited times and locations. Through provider training, services are now available much closer to where women live, reducing missed opportunities and improving access across communities.

The field visit to Barangay Cabancalan brought these concepts to life.

Conversations with barangay leaders and frontline providers underscored the importance of local ownership in sustaining health programs. Barangay officials described their active role in identifying community needs, mobilizing residents, supporting outreach activities, and allocating local resources. The visit demonstrated how city level policies and investments are translated into community level action through strong partnerships between local governments and frontline implementers.

The debriefing discussion reinforced the value of governance and systems strengthening approaches. While investments in leadership, governance, planning systems, and financing mechanisms may appear less tangible than direct service delivery, they often have greater long term impact because they influence how decisions are made, how resources are allocated, and how programs are sustained.

Particular interest was expressed in understanding the relationship between city governments and barangays, especially in areas such as planning, budgeting, and shared accountability. These discussions highlighted the importance of cultivating ownership at multiple levels of the local health system.

The conversation also explored how lessons from successful cities can be adapted and replicated elsewhere. Knowledge products such as implementation playbooks and city case stories generated interest because they provide practical guidance for other local governments seeking to strengthen health systems and improve outcomes in their own settings.

An important reflection from the visit was the natural alignment between maternal and child health and broader human development objectives. While sectors and organizations may use different language and frameworks, many are ultimately working toward the same goal: improving the well-being of children, families, and communities.

The visit reinforced a lesson that has consistently emerged across TCI cities. Sustainable improvements in health outcomes are rarely the result of a single project or intervention. They are achieved when local governments strengthen leadership, governance, financing, service delivery systems, and community ownership in ways that endure beyond external support.

Mandaue City provided a compelling example of how this approach can work in practice. More importantly, it demonstrated that when systems are strengthened, the benefits extend far beyond any single health program and create conditions for lasting impact across the broader health and development agenda.

Author: Dr. Anthony Faraon, ZFF TCI-Philippines Chief of Party

Tacurong City sits at a crossroads in South Central Mindanao, serving as Sultan Kudarat’s commercial hub. It’s the smallest but most crowded area in the province, with over 109,000 people. As the main center for healthcare and education, it draws communities from nearby provinces. Yet growth brings challenges, especially in security and public health. The city urgently needs more accessible and complete family planning services.

Finding the Gaps

In 2021, Tacurong joined The Challenge Initiative (TCI), a global program implemented in the Philippines by the Zuellig Family Foundation (ZFF). It helps local governments launch and sustain effective family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) solutions.

Related article:

• Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health

Through a Program Design Workshop, leaders examined what blocked AYSRH and identified action items to improve the status quo: 

• Strengthening the AYSRH committee. It existed in Tacurong City but needed clearer structure and purpose.
• Enhancing training for health staff on AYSRH. Providers needed skills to talk comfortably with teens.
• Developing adolescent-specific strategies beyond DOH (Department of Health) programs as most services focused on adults and children.

Building Stronger Leadership

After the workshop, former Mayor Lino Montilla formed the City Leadership Team (CLT). This created a strong inter-agency system that united different departments and mobilized barangay officials and youth groups. Gary Bañas, Social Worker and Population Program Officer, recalled, “The program design was followed consistently, which integrated adolescent programs across different sectors, especially schools and communities. Collaboration between the LGU (Local Government Unit), Commission on Population and Development (CPD), DOH, and partners made it possible to accelerate adolescent-friendly health services in the city.”

Through TCI, the city built both structure and skills. Coaching helped the CLT lead and sustain changes. Current Mayor Lina Montilla credits TCI for knowledge that strengthened her leadership and helped Tacurong champion AYSRH more effectively.

Creating Services Teens Can Trust

A major step was establishing adolescent-friendly health facilities (AFHFs). These provided resources and trained staff ready to serve without judgment. Nurse and Family Planning Coordinator Gina Ramiscal noted that few young people sought care before. “They either didn’t know services existed or were afraid they would be judged,” she recalled. Adolescent Sexual and Reproductive Health Coordinator Richyle Mae Gallenta added, “Young people used to visit health centers alongside regular patients, which created discomfort because there was no privacy.”

The city expanded programs including the Buntis Class and Healthy Young Ones, giving young people health information and safe spaces to learn.

Young mothers felt the impact directly. Ana*, 19, and Bella*, 22, shared their stories. A felt fear, regret, and uncertainty when she discovered her pregnancy. She felt grateful for Laarni Ecalla, midwife from the Upper Katungal Health Center and President of Midwives in Tacurong. Together with Kagawad (“barangay councilor”) Expedito Ramay Jr., Chairperson on Health, Ecalla provided counseling and seminars for young mothers. B learned from her experience to delay pregnancy, warning it can be extremely difficult both physically and financially.

Kagawad Ramay expressed hope for livelihood programs for teenage mothers with the Department of Social Welfare and Development (DSWD). “We believe young mothers should become champions who can encourage and support other teenage mothers in our community,” he said.

Mayor Lina Montilla stressed working closely with the Department of Education (DepEd). Guidance counselors and teachers became key allies in reproductive health education. As she emphasized, “By working with schools and guidance counselors, we ensure that young people find trusted adults they can turn to for advice on health and family planning.”

Reducing Reliance on Outside Help

To secure lasting impact, Tacurong passed local ordinances that institutionalized AYSRH. The city set aside dedicated funds for family planning and adolescent health.

“Family planning and adolescent health are now priorities in Tacurong. These programs are embedded in the Gender and Development (GAD) funds and the city’s budget. We are assured of sustainability because policies are in place,” Mr. Bañas noted.

Mayor Montilla echoed this commitment: “Our ordinances and teen centers are not just policies on paper; they are lifelines. We invested city funds so that services will continue regardless of changes in administration or external programs.”

Seeing Real Results

By 2024, Tacurong’s adolescent birth rate (ABR) dropped significantly compared to 2020, from 34 births to 26. The modern contraceptive prevalence rate (mCPR) stayed above the national target of 30%, showing greater trust in available services.

Community education and youth symposiums shifted attitudes at home. As Ms. Ecalla shared, “Pregnancies among very young girls have dropped. Parents are more open to talking about reproductive health. The conversations are happening in barangays where adolescents visit health facilities together with their parents and are directed to counselling rooms for additional support.”

Today, all health facilities in Tacurong are certified as adolescent-friendly. Every staff member is trained to provide these services.

The city also invested in data monitoring. Regular checks helped the team track progress and adjust. As Ms. Gallenta put it, “Data has become our guide. It tells us what is working, where we need to improve, and how we can better serve young people.”

Making It Last

Tacurong’s transformation is not temporary. With supportive policies, dedicated budgets, and teen centers, the city built a system meant to endure. Challenges remain. Ms. Ramiscal noted, “Program coordinators wear several hats. No one has a role specific to family planning and adolescent health.” Still, the city stays determined to reduce adolescent pregnancies and prevent repeats among young mothers.

Tacurong’s journey shows that sustainable progress is possible. The city moved from fragmented, externally dependent programs to a resilient, locally led system. The lesson is simple yet powerful: when leaders prioritize adolescent health and invest in both people and systems, communities thrive.

As Mayor Montilla concluded, “Every adolescent deserves the knowledge, services, and support to build a healthier future. When we empower young people with knowledge about reproductive health, we don’t just protect them, we secure the future of Tacurong’s families.”

* Name has been changed to protect the identity of the young mothers.

Banner photo: Courtesy visit to Tacurong City, where Barangay Enrique JC Montilla Health Center and Grino Super Health Center were recognized for delivering high-quality family planning services to women of reproductive age and adolescents. They were welcomed by City Councilor for Population Lalaine Montilla, together with Councilor Harvey Legas of the Health Committee.

Isabela de Basilan draws strength from its diversity. The city is home to 130,379 people who speak Chavacano, Tausug, Yakan, and other languages. Many residents practice Islam, while others come from Indigenous and Christian communities. This mix of cultures now shapes how the city delivers family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) services.

In August 2023, Isabela de Basilan joined The Challenge Initiative (TCI), implemented in the Philippines by the Zuellig Family Foundation (ZFF). TCI supports local governments in strengthening FP and AYSRH programs. Earlier that year, Mayor Sitti Djalia Turabin-Hataman, known as Mayor Dadah, had already set the direction. In February 2023, she signed Executive Order No. 005, creating the City Leadership Team (CLT) to guide and coordinate reforms across the city.

Instead of treating faith and culture as obstacles, city leaders chose to work with them.

Related article:

• Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health
• Ang Pamilyang Planado, Panalo: Isabela de Basilan’s Efforts in Family Planning

Naming the Challenges

In October 2023, 21 members of the CLT took part in a Program Design Workshop. During the sessions, they openly examined gaps in the local health system. By November 2023, the team translated these discussions into an approved Work and Financial Plan.

The workshop surfaced several concerns:

• Governance gaps: The city lacked a permanent body focused on FP and AYSRH. Offices worked in silos, and the city had no digital health information system.
• Service delivery issues: Health workers needed more training to counsel clients and provide modern contraceptive methods such as Progestin Subdermal Implants (PSI) and Intrauterine Devices (IUDs). Island communities struggled with irregular access to supplies. The city also had too few Levels 1 and 2 Adolescent-Friendly Health Facilities (AFHF).
• Social and cultural barriers: Advocacy activities reached only some communities. Early marriage and teenage pregnancy remained sensitive and deeply rooted concerns.
• Youth support gaps: The city had limited numbers of trained peer educators and safe spaces where adolescents could seek help.

These gaps affected island and remote communities the most.

The city united around a shared vision: “By 2029, young Isabeleños will be empowered, responsible, well-informed and engaged in AYSRH and FP with good governance and through a collaborative, intercultural, and sustainable approach towards living their lives to the fullest.”

Using Technology to Improve Care

The city strengthened its response by adopting Wireless Access for Health (WAH), a digital platform that now serves as its first Electronic Medical Records (EMR) system. Health workers now use real-time data, track family planning counseling sessions more accurately, and link records with PhilHealth eClaims.

Health indicators show early progress. Since 2020, the adolescent birth rate has steadily declined and remains within the national target of fewer than 37 births per 1,000 adolescents. Although the modern contraceptive prevalence rate has not yet reached the 30% benchmark, earlier gains point to strong potential if the city sustains its investments.

Creating Space for Faith and Dialogue

In 2024, during the 2nd Indigenous Peoples Celebration, the city organized its first Adolescent Pregnancy Summit under the theme “Empowering Leaders: Indigenous Voices in Adolescent Pregnancy Prevention.” The event brought together community leaders, Islamic scholars, and health advocates for open and respectful dialogue.

Atty. Nur-Aiza Gagarra, Provincial Cooperative Officer and FP champion, presented “Early Pregnancy and Islamic Belief (Fatwa)” and linked Islamic teachings with Republic Act No. 11596. Jasmin Teodoro, Executive Director of Pinay Kilos Inc., led sessions on AYSRH and facilitated a “speed dating” activity to help participants practice healthy communication.

Participants ended the summit with a hand-painting ceremony led by Miriam Suacito, Executive Director of Nagdilaab Foundation Inc., to affirm their shared commitment to protecting young people.

Letting Young People Lead

The Local Youth Development Office and the Sangguniang Kabataan (SK) Federation mobilized youth groups, especially on Malamawi Island, to address early pregnancy and other adolescent concerns. SK chairpersons allocated funds through their Comprehensive Barangay Youth Development Plans and Annual Barangay Youth Investment Programs.

These investments strengthened Teen Centers, School-Based Teen Centers, and the Information Service Delivery Network (ISDN) for Adolescent Health and Development. These spaces allow adolescents to seek services without fear or judgment and help peer educators reach other young people in culturally sensitive ways.

Building Systems That Respect Diversity

Today, the CLT functions as a strong coordinating body. City offices use Gender and Development (GAD) funds to sustain programs across communities. At the same time, the EMR system records not only medical data but also language needs and cultural considerations, helping providers deliver more responsive care.

Isabela de Basilan shows that cities can pair modern systems with cultural respect. Its experience proves that progress does not require communities to abandon their beliefs. Instead, it calls on health systems to listen, adapt, and work closely with the people they serve.

The Challenge Initiative (TCI) is a global platform that supports cities and local governments to rapidly and sustainably scale up proven primary health care solutions, particularly family planning. Rather than introducing new or parallel interventions, TCI transfers evidence-based strategies that are already known to work and supports local governments in institutionalizing these approaches within their own systems. By strengthening leadership, management, and data use at the local level, TCI achieves strong results at scale while promoting long-term sustainability. At a time of shrinking global health funding, this direction offers exceptional value for money—protecting past gains while enabling countries to expand impact with fewer external resources.

The year 2025 marked a challenging transition for TCI with its project completion. For country teams, including ours in the Philippines, 2025 raised critical questions about continuity, expectations, and sustainability. How would momentum be sustained? What would the next phase demand in terms of focus and capacity? And how could gains in family planning and adolescent, youth, and sexual and reproductive health be protected amid tighter global financing?

These questions were very much present as I travelled to Senegal to attend the TCI Global Chief of Party Meeting. There was a strong need for clarity on strategic direction, operating models, and performance expectations. Like many colleagues from other hubs, we arrived seeking reassurance and a clearer understanding of how TCI would move forward.

What the meeting ultimately provided was a shared perspective. Listening to the experiences of other hubs across Africa and Asia made it clear that the Philippines was not alone in navigating uncertainty. Many teams had faced similar transitions, pressures, and doubts. At the same time, they shared stories of adaptation, resilience, and continued impact. This collective reflection helped normalize the challenges of the past year and reinforced a shared sense of purpose across the global TCI community.

The discussions were grounded in realism. TCI is operating in a global environment where development assistance for health is increasingly constrained, making efficiency and focus more critical than ever. The meeting acknowledged these realities openly, including leaner global support structures and the need for greater hub-level autonomy. Importantly, this shift was framed not as a setback, but as an evolution toward a more mature and sustainable operating model.

For the Philippines, this message resonated strongly. Over the past years, TCI, in partnership with the Zuellig Family Foundation, has demonstrated its role as a powerful scale-up engine, enabling cities to rapidly expand access to modern family planning services using proven approaches. By working through local governments, TCI strengthens health systems, builds institutional capacity, and embeds data-driven decision-making where it matters most. These are not short-term wins, but foundational improvements designed to endure beyond external support.

This is precisely why TCI matters now more than ever. In a context of shrinking global health budgets, TCI’s model delivers high impact at relatively low cost. By leveraging existing systems, local leadership, and tested practices, TCI maximizes return on investment while reducing long-term dependence on donor funding. It protects what has already been achieved and enables countries to do more with less.

The global meeting reinforced this value proposition. Despite the uncertainties experienced in 2025, the collective results from the NextGen phase demonstrate TCI’s credibility and global reach. Across multiple countries, TCI-supported cities have reached millions of women with family planning services, contributing to healthier families and stronger communities. These results are measurable, well documented, and replicable across diverse contexts.

Encouragingly, the meeting also brought clarity and optimism about the future. Continued funding from Bayer, alongside ongoing discussions with other partners, signals sustained confidence in TCI’s approach. While resource mobilization remains a shared responsibility, the opportunity ahead is clear. TCI offers a compelling platform for donors seeking efficient, scalable, and sustainable investments in primary health care and family planning.

For our team in the Philippines, the meeting was both affirming and energizing. It validated the strategic direction we are taking under TCI 20.30, with an emphasis on prioritization, operational efficiency, and strong local ownership. Approaches such as clustered city support, streamlined reporting, and practical, on-demand access to knowledge at the facility level align well with the global push to simplify systems while safeguarding results.

Leaving the meeting, the uncertainty that characterized much of 2025 gave way to clarity, reassurance, and confidence. TCI is entering its next phase not as an untested initiative, but as a proven mechanism for translating global evidence into local impact. For governments, partners, and donors committed to advancing primary health care and family planning, TCI represents an opportunity to protect past investments and scale what works in a way that is efficient, locally led, and built to last.

Author: Dr. Anthony Faraon, ZFF TCI-Philippines Chief of Party

General Santos City (GenSan) had trained health workers, functioning facilities, and national support for family planning (FP). Still, many families—especially in far communities—had limited access to modern contraceptives, particularly long-acting reversible contraceptives (LARCs), which can protect women for years. 

During the pandemic in 2020, modern contraceptive use was only 30%, and LARC use was low across the city. Beyond distance, a key problem was that offices worked in silos, leading to fragmented services and unclear data.

City leaders and advocates also saw gaps in data. Judith Janiola, Head of the City Population and Management Office (CPMO); Desiree Garganian, Regional Director (RD) of the Commission on Population and Development (CPD) Region XII; and Angelina Paule, President of the United Private Midwives of GenSan City, Inc. (UPM), shared that weak and inconsistent reporting hid the real picture of contraceptive use and adolescent pregnancy. This made it harder to design programs based on evidence.

Related article:

• Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health

 

In 2023, the city issued Executive Order No. 95-A creating the Family Planning Itinerant Team (FPIT) to reach underserved areas.

With support from the Zuellig Family Foundation through The Challenge Initiative (TCI)-Philippines, the Department of Health (DOH)-Region XII, and CPD-Region XII, GenSan also revived its City Leadership Team (CLT). Backed by former Mayor Ronnel Rivera and Mayor Lorelie Pacquiao, the CLT brought together health, education, social services, youth leaders, and community groups. The review confirmed that offices were not sharing data and that adolescent needs were often overlooked.

GenSan responded by aligning departments around shared data and goals. As RD Garganian noted, “General Santos was willing to lead, build capacity, and maximize TCI’s role in addressing these fundamental challenges.” A city directive required offices to share health data, helping teams see gaps and plan together. Providers were trained through the Family Planning Competency-Based Training (FPCBT), which gave hands-on skills in LARC insertion and removal, and strengthened adolescent-friendly, respectful care.

Trust and community outreach were central. “Earning the trust of clients is crucial,” Paule shared. “Our Enhanced Usapan sessions worked well because they didn’t just inform people about family planning—they also connected them directly to services.” Janiola added, “Family planning is not just about providing methods. It’s about improving quality of life. That’s why we emphasize informed choice and voluntarism.” Barangay nutrition scholars conducted house-to-house visits, and all facilities were upgraded to meet DOH standards for adolescent-friendly services.

The results were clear. All 46 identified providers completed postpartum FP training, and all health facilities earned DOH certification as adolescent-friendly. With cleaned and harmonized data, GenSan established accurate baselines. Modern contraceptive prevalence rate (mCPR) rose from 30% in 2020 to 34% in 2024, exceeding the national target of 30%. LARC use more than doubled—from about 8,000 users in early 2021 to over 20,000 by mid-2025.

GenSan’s experience shows that lasting gains come from system-wide coordination, strong leadership, trained providers, and shared data. As RD Garganian emphasized, “The GenSan experience was unique… showing that the city’s sustainability can go beyond external support.” For Janiola, the work continues: “With General Santos in such a strong position, we can only hope for more—more policies supporting family planning and adolescent health, and more advanced data collection and monitoring systems.”

Banner photo: GenSan mobile implant outreach

Tagum City, the capital of Davao del Norte, is a fast-growing urban center in Mindanao. Alongside its growth came persistent challenges in reproductive health, especially the unmet need for family planning (FP)—referring to women who want to delay or avoid pregnancy but are not using any modern FP method due to barriers such as limited access, lack of information, or social norms.

In 2023, the City Government of Tagum, under Mayor Rey Uy, partnered with the Zuellig Family Foundation through The Challenge Initiative-Philippines (TCI), the Department of Health (DOH)-Region XI, and the Commission on Population and Development (CPD)-Region XI to strengthen FP and adolescent and youth sexual and reproductive health (AYSRH) programs. 

Related article:

• Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health

 

Putting Communities and Youth at the Center

Even before TCI’s support, Tagum had community health efforts in place. However, limited resources meant these efforts were often fragmented. The city saw the need for a more coordinated and data-driven approach—one that addressed both demand for and supply of services.

Through the City Leadership Team (CLT), local offices, health providers, and community partners aligned around a shared strategy. This included Teen Tambayan Centers and the revitalized Usapan Serye, which brought structured and culturally sensitive discussions on FP and AYSRH to barangays and schools.

Youth played a key role as peer educators, especially in geographically isolated and disadvantaged areas (GIDAs). Their involvement helped normalize conversations on topics often seen as taboo.

“What began as a campus health forum for high school students has grown into a citywide movement—reaching elementary students, college youth, parents, and communities. By partnering with schools, the Parent-Teachers Association, Sangguniang Kabataan, and youth volunteers, Usapang Youth has expanded from classrooms to the streets, ensuring that health education and support truly meet young people where they are,” shared Edu Macabatas, Head of the Tagum Youth Development Office.

Community sessions complemented school-based activities. Dr. Dainah Casintahan Fajardo, City Health Division Chief, emphasized, “Because the city chooses to invest in its young people, with the help of TCI, we’ve grown from focusing only on the highest-need areas to now reaching all 23 barangays. With sustained funding for adolescents, we bring advocacy from schools to communities, ensuring every young person in Tagum is informed, empowered, and protected.”

Engaging Men and Shaping Shared Responsibility

Tagum also made sure men were part of the conversation. Through KATROPA (Kalalakihang Tapat sa Responsibilidad at Obligasyon sa Pamilya) and the locally developed Mr. GAD-PEGAD (Men’s Responsibility on Gender and Development–Parent Education on Gender and Adolescent Development), male leaders were engaged on gender equality, responsible parenthood, and reproductive health.

Messages That Reach and Resonate

To reach more people, Tagum invested in localized communication. Radio programs, social media posts, and printed information, education, and communication (IEC) materials used local language and real stories to build trust.

“Young people are naturally curious, and their questions—no matter how unexpected—deserve clear, honest answers. With localized IEC materials in their own language, we can bridge gaps in understanding, spark meaningful conversations, and guide them toward informed choices in family planning and adolescent health,” shared Charlene Gastanes Lanoy-Osido, Adolescent Health Development Program Coordinator.

Bringing Services Closer

Access to services improved through institutionalized Fixed-Day Services (FDS) at health facilities and mobile outreach for GIDA barangays. These ensured regular availability of both short-acting and long-acting contraceptives.

The city also responded to rising human immunodeficiency virus (HIV) cases among young people by offering free testing. “Rising HIV cases remind us how vital awareness and early testing are—especially for the young. By offering free HIV testing, we turn fear into action, empowering people to know their status and protect their future,” shared City Population Officer Dulce Amor Alcaraz.

With TCI support, midwives and nurses were trained in long-acting reversible contraception (LARC), including postpartum intrauterine device (IUD) insertion.

“Because of TCI’s support in training our family planning providers, services are now within reach. In every barangay, trained nurses are ready to serve, making quality care accessible right where families live. When a trained provider is just a few steps away, family planning becomes a choice everyone can freely and safely make,” Alcaraz added.

Continuous mentoring strengthened provider confidence and client-centered care. “Through Family Planning Competency-based Training (FPCBT), we’ve learned that counseling is just as important as the procedure itself. When clients fully understand their choices, they make informed decisions that protect their health and future—ensuring family planning is not just available, but truly empowering,” shared Archilee Cortado, FP Coordinator.

Results That Last

Tagum embedded FP and AYSRH into local policies, plans, and budgets—moving them beyond short-term projects. The City Health Office and City Population Office continue to lead multisectoral coordination through the CLT.

This approach led to measurable gains. The modern contraceptive prevalence rate (mCPR) steadily improved—from 35% in 2020 to 45% by 2024—exceededing the national target of 30%. The adolescent birth rate (ABR) rose from 38 per 1,000 live births in 2020 to 51 in 2022—above the benchmark of 37. By 2024, it dropped sharply to 32, meeting the national standard and reflecting the impact of sustained interventions.

Additional results include a 95% quality implementation score for postpartum FP, 83% gender integration in FP programming, and the inclusion of FP High Impact Practices in the city’s Annual Operational Plan and budget.

A Model Rooted in People

Tagum’s experience shows that lasting change begins with listening—using local language, trusted messengers, and data to guide action. By engaging youth and men, strengthening services, and embedding programs into governance, the city built a resilient and people-centered health system.

Tagum City’s journey proves that with strong local leadership and genuine community engagement, family planning can move from policy to practice—one conversation, one service, and one family at a time.

Banner photo: A Teen Tambayan Center of Tagum City

The Indonesia landscaping workshop last December 2025, in partnership with Jalin Foundation and supported by The Challenge Initiative (TCI)-Philippines and global colleagues, offered a rare glimpse into a country with a rich family planning (FP) history and a health system in active transition. Designed to help local partners prepare for the launch of the new TCI Indonesia Hub, the workshop surfaced valuable insights about Indonesia’s strengths, complexities, and emerging opportunities for impact. 

A Strong National FP Foundation 

Indonesia’s national FP program reflects decades of progress and remains one of the strongest in the region. The 2024 Family Data Update highlights a modern contraceptive prevalence rate (mCPR) of 62.38% among married women, alongside a stable method mix dominated by injectables and pills, with gradual growth in implants and IUDs. These indicators demonstrate a solid foundation on which cities and districts can continue expanding FP access and strengthening quality of care. 

A notable structural feature is that these indicators apply only to married women, as public facilities provide FP services exclusively to married clients. Adolescents and unmarried women typically rely on private providers and pay out of pocket—a big difference from the Philippine context, where FP services in public facilities are universally available regardless of marital status. 

City-Level Diversity as an Opportunity 

Beneath Indonesia’s strong national picture lies significant variation across cities, not as weaknesses, but as opportunities for more tailored, context-driven strategies. mCPR among married women ranges from 37.9% in Central Jakarta to 61.2% in Bandung, while unmet need* ranges from 16.0% to 35.0%. Several cities are already surpassing national targets for long-acting reversible contraceptives (LARC) uptake, while others show steady upward trajectories. 

This diversity underscores the value of localized action plans and city-led decision-making—precisely the environment where TCI’s coaching approach can help accelerate progress. 

Urban Realities: A Unique Set of Challenges and Strengths 

Indonesia’s cities present a mix of robust service platforms and distinct implementation challenges. With more than 53,000 FP service points, the country benefits from wide availability of services. A unique feature is the strong presence of independent midwife practices, which provide FP services to 36.46% of married women, a larger share than in the Philippines, where public health centers are the primary FP providers. 

Workshop discussions highlighted several key opportunities for Indonesia’s cities: 

• Supporting FP method continuation in fast-paced urban environments.
• Strengthening counselling and side-effect management to reduce switching and discontinuation of FP methods.
• Enhancing postpartum FP, especially given the country’s high postpartum visit coverage (77.63% nationally). 

These are natural challenges in any large, diverse urban setting—the very challenges that TCI aims to help cities address through practical tools, coaching, and evidence-based interventions. 

A Decentralized System With Parallels, and Distinctive Features 

Indonesia, like the Philippines, operates a decentralized governance system where districts and cities oversee FP implementation. The two countries share common experiences related to varying local priorities, the importance of local champions, and the need for strong coordination across sectors. 

However, Indonesia’s system also has distinct characteristics, including: 

• Centralized procurement of FP commodities handled by BKKBN (Badan Kependudukan dan Keluarga Berencana Nasional, “National Population and Family Planning Board”), ensuring national-level consistency in supply. 
• Implementation led by district and city health offices, creating a clear division between national procurement and local service delivery. 
• Strong community-based cadres, such as the TPK (Tim Pendamping Keluarga, “Family Support Team”), who play an active role in family development and outreach. 

These features shape Indonesia’s FP landscape in unique ways and offer a clear structure for where TCI support can add value. 

FP at the Center of Human Capital Development 

One of Indonesia’s strongest assets is its ability to position FP within a broader development vision.  Under BKKBN’s 2025–2029 Transformation Priorities, FP is deeply connected to: 

• reducing stunting, 
• supporting youth development, 
• strengthening family resilience, 
• driving digital innovation through tools like SIGA (Sistem Informasi Keluarga, “Family Information System”), and 
• advancing community-based behavior change. 

This framing aligns FP with Indonesia’s long-term human capital goals, creating a powerful foundation for TCI to build upon as it supports cities in designing integrated, family-centered FP strategies. 

Looking Ahead 

The workshop revealed a country that is not only committed to FP, but also fully prepared to take its next strategic leap. Indonesia’s strong policy environment, extensive service delivery platforms, and energized local actors create an ideal landscape for the establishment of the TCI Indonesia Hub. 

The momentum is clear: city leaders, local health offices, community cadres, and national counterparts all demonstrate readiness to adopt practical, and scalable approaches. With TCI’s coaching support, Indonesia is well-positioned to accelerate the translation of national priorities into city-level results, particularly in expanding choice, improving service quality, and reaching underserved urban populations. 

* Unmet need refers to the proportion of women of reproductive age who want to delay or stop childbearing but are not using any method of contraception.

Author: Dr. Anthony Faraon, ZFF TCI-Philippines Chief of Party

Lapu-Lapu City in Central Visayas faced a rising adolescent birth rate (ABR), increasing from 14 births per 1,000 adolescents in 2020 to 23 in 2023. At the same time, modern contraceptive prevalence rate (mCPR) dropped from 31% to 21%. Local health officials saw that, while women continued to seek services, many still relied on short-acting family planning methods. Uptake of long-acting options was growing but needed stronger community support.

To respond to the alarming numbers, the city partnered with The Challenge Initiative (TCI), a global program implemented in the Philippines by the Zuellig Family Foundation that helps local governments scale proven family planning and adolescent and youth sexual and reproductive health (AYSRH) solutions. 

Related articles:

• Nine Cities Recognized as Global Self-Reliant Cities in Reproductive Health
• Lapu-Lapu City’s Path to Strengthening Family Planning and Adolescent Health

 

The city formed the Lapu-Lapu City Leadership Team to unite health, education, youth, and social welfare sectors. Barangay nurses and midwives then began integrating meaningful conversations into routine services. They learned that many adolescents lacked parental guidance and reliable reproductive health information, while many adult women feared modern methods because of misconceptions. These issues showed that rising adolescent pregnancies and declining contraceptive use stemmed from the same need: trusted, judgment-free health information within the community.

Lapu-Lapu City placed communities at the center of its strategy. Awareness efforts shifted the conversation from contraceptives alone to responsible parenthood. 

Barangay Health Workers (BHWs)—trusted members of each neighborhood—played a central role. Through house-to-house visits, they profiled households, explained family planning options, and corrected myths using simple materials. BHW Coordinator Jovy Alonzo emphasized that all BHWs are trained in adolescent health and development and uphold confidentiality and nonjudgmental support. Their strong performance earned Lapu-Lapu’s BHWs the Performance-Based Incentive (PBI) Award for two consecutive years, making them PBI Champions in Central Visayas. As Nurse Grace Mary Chan-Carunggay shared, “This recognition is a testament to their exceptional service and dedication.”

The city also strengthened its service delivery system by training more providers through Family Planning Competency-Based Training (FPCBT), especially in barangays with limited access. This allowed more health centers to offer long-acting reversible contraceptives (LARC), including the Progestin Subdermal Implant. City leaders supported these improvements by funding BHW incentives and training, conducting regular barangay visits, and ensuring data quality for planning. According to City Health Officer Dr. Agnes Cecilia Realiza, “Adolescent parents are now coming to our health centers. They no longer feel stigmatized, and they seek prenatal care, ensuring the safety of both mother and child during delivery.”

In 2024, the city recorded only one additional adolescent pregnancy case, showing early signs of progress. The drop in mCPR was largely due to data cleaning, which corrected the number of women counted in the program. Lapu-Lapu is also adjusting to the shift in national indicators—from mCPR to “demand satisfied”, or the share of women with a need for family planning who use modern methods. The City Health Office continues to improve staff capacity for accurate data use and coaching.

Lapu-Lapu’s experience shows the power of community-centered, data-driven leadership. By investing in AYSRH and allocating dedicated budgets, the city has strengthened the work of BHWs and sustained community engagement. With a 22% increase in AYSRH budget commitments, based on TCI-Philippines monitoring, Lapu-Lapu demonstrates that empowering frontline workers creates lasting impact—helping young people make informed choices for their health and future.