Assessing the Sindh Government’s Responsiveness to Family Planning Interventions Using the Challenge Initiative (TCI)’s Innovative Reflection and Action Tool

Abstract

Background: The Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool is a management framework incorporating a responsive feedback (RF) mechanism to assess and strengthen government self-reliance in delivering high-impact interventions. It comprises six domains aligned with the World Health Organization’s (WHO) Six Building Blocks of Health Systems.

Methodology:  This study, conducted from September 2022 to December 2024 in eight urban districts of Sindh, involved seven assessment cycles. The RAISE tool was adapted to the local context and applied to four domains: Political and Financial Commitment, Capacity Strengthening, Institutionalization of Proven Approaches, and Sustained Demand. A structured multiphase process guided the assessment, including pre-workshop reviews, small-group evaluations, large-group discussions, action plan formulation, and follow-up monitoring in collaboration with local government and stakeholders.

Results: At baseline, all districts were at Stage 1, with an average score of 30%. Across seven assessment rounds, substantial improvements were recorded across health system building blocks, with notable gains in leadership, governance, commitment, and financial systems. Persistent challenges were identified in supervision and community engagement. By the end, all districts progressed to the Stage 3 (Expanding phase), surpassing 70 percent indicating improved sustainability in family planning programs.

Conclusion: The RAISE tool effectively enhanced family planning interventions and government responsiveness in Sindh, promoting continuous improvement and evidence-based decision-making. Future efforts should address persistent service delivery gaps and explore the tool’s scalability to other regions.