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In Their Own Words: Using Data for Decision-Making in Bareilly Helps TCIHC Accelerate Work
Suritesh Dagur serves as city manager for The Challenge Initiative for Healthy Cities (TCIHC) in Bareilly, the eighth largest city in Uttar Pradesh. Before transferring to Bareilly, she worked with the government of Saharanpur - one of the first five TCIHC cities - to scale-up TCIHC's proven interventions. Below, she reflects on what she learned from her work in Saharanpur and how she used those learnings to make progress in her new TCIHC city of Bareilly. 

"My story goes back to the time when I had joined TCIHC as the City Manager of Saharanpur. After working for a year in this city known for its wood carving, I had managed to accelerate the uptake of family planning solutions in its urban primary health centers (UPHCs). But, my success story in Saharanpur took a twist when I was transferred to Bareilly - a new TCIHC city in Uttar Pradesh. This sudden transformation brought back the same feeling I had when I joined Saharanpur a year ago. I felt I was at ground-zero again, but I also sensed responsibility and high expectation for myself. I wanted to replicate the success of Saharanpur in Bareilly. I reflected back on my experience in Saharanpur, and I realized that I knew how the system works, the process and very well understood the way I had to move forward with my mission."

As I landed in Bareilly, I felt an 'air of indifference' in the system as if everyone had accepted the way things were. Most of all I found that the system behaved differently from what I was used to in Saharanpur and people were not ready to accept TCIHC - which was the way in Saharanpur too at the beginning. I knew the best way to activate the system was to demonstrate a result that the health leadership of Bareilly had never achieved from urban areas until now. So, I started by getting orders for the special fixed day static service/family planning day (FDS/FDP) (also referred to locally as 30-hour magic +) for two facilities to coincide with World Population Day. The situation was not at all in our favor as supplies and instruments were missing from the UPHCs. I managed to arrange for the IUCDs kits and infection prevention equipment and instruments were borrowed from a private facility to give quality services to the clients. However, the biggest hurdle was untrained service providers as no staff nurse was trained on IUCD insertion in Bareilly. I ran around to get special orders from the Chief Medical Officer (CMO), who asked the facility Medical Officers to be on duty on the day of FDS. My team of field program assistants (FPAs) and field program coordinators (FPCs) worked hard in the field with the frontline workers [ASHAs and AWWs] to mobilize potential clients. The way we worked around the clock to make FDS a successful event was a shock to the system."

On July 19, 2018, we had our first FDS in Bareilly at two facilities - UPHCs in Gher Zafar Khan and Subhash Nagar. It was like a fair. Twenty-seven clients voluntarily chose to get an IUCD inserted on this single day at both facilities. It was the largest number of IUCD accepters in an urban area of Bareilly to date. The results were shared with all the government officials. They were happy with the results, but the results were not enough to break the ice. Soon, FDS became a one-day wonder for the system."

The high impact approach (HIA) tools helped me a great deal whenever I encountered a dilemma. I had used them many times in Saharanpur, but now it was time to do the same in Bareilly in order to get good results. Although the HIAs are very impactful at all engagements with stakeholders, the data for decision-making tool is one that can break the ice anywhere. The best part is that government already has data in its system through HMIS and other reports. Data comparison at any point of time (between the HMIS and project records) is a very good tool for any project as it is the only way by which the performance can be measured and helps inform decision-making as well. I used data for decision-making as an advocacy tool after the FDS and the results had poured in for FP uptake. I went to the office of the National Urban Health Mission (NUHM). Luckily, that day the NUHM Nodal Officer, Urban Health Coordinator and the City Community Process Manager (CCPM) were all in the office. I had made up my mind that today is the day when I will break the ice and present our project as their own necessity. I needed for them and the system to own the project. With this thought, I requested the Data Cum Accounts Assistant (DCAA) to share the file of monthly reports. DCAA had her apprehensions and did not comply with my request at first, instead she asked me to speak to the Nodal Urban Officer since she saw the data is proprietary and sensitive to those outside the system. I was prepared for this situation, so I spoke to the Nodal Urban Officer and convinced him that the only way to move forward with FP programming in the city was to analyze the data from HMIS. I explained to him that data is the only way by which we will be able to understand the situation right now and help the system in further planning for FP. The Nodal Urban Officer was convinced and directed the DCAA to provide the data."

As expected, the HMIS data on family planning hadn't been analyzed and whatever data that was submitted from the UPHCs were still in the hard copy. The DCAA had no clue as to whether correct reporting was being done or not. I analyzed the reports for June 2018 to July 2018 and prepared a presentation along with the excel sheet of the reports. The analysis showed many discrepancies, such as many UPHCs reporting PPIUCDs, which was actually being done at the District Women's Hospital. Another major flaw was that the NUHM - which oversees the public health sector - was reporting services provided at the private facilities by their ASHAs in their own reports. These findings were compared to last year's reports. The difference in the report that I prepared from the FDS versus what was being submitted by the UPHCs was eye opening for them."

The NUHM team said that this is a really grave issue that the right reports are not coming in from the UPHCs. The Nodal Urban Officer asked me to 'Kindly share the reports with us over email. The one which you have prepared is the right one. We want to understand the performance of UPHCs.' The NUHM team also made a note that 'data anomaly' and wrong reporting were major issues to be discussed during the next review meeting."

At this time, the Urban Health Coordinator said, 'We never knew that the reports were wrong; I request you to kindly check the data of our UPHCs regularly. In fact, you can take the reports weekly from our facility and share with us, so that at the month end, we have the right report to be presented in our review.' The moment he said this, I introduced TCIHC's data for decision-making tool to him. I briefed him on how the specified indicators and steps mentioned in this tool help to monitor and do better activity planning. He was very impressed with the way TCIHC works, and immediately created a WhatsApp Group ... to have correct FDS reports on the same day as they occur. This was the day when NUMH and the system recognized TCIHC's value and better understood that we are here to help strengthen their system."

Later, the Nodal Urban Officer and Urban Health Coordinator asked me to coach the pharmacists and medical officers of the UPHCs on how a report should be prepared. He further prepared a schedule of joint visits of CCPMs and FPCs to UPHCs so that the CCPMs can better understand the reports and how they are to be prepared correctly. This was the turning point for the TCIHC in Bareilly."

For reading this story on TCI University please https://tciurbanhealth.org/in-their-own-words-using-data-for-decision-making-in-bareilly-helps-tcihc-accelerate-work/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

In Their Own Words: NUHM Deputy CMO in Mathura Likes Innovations Found in TCI University
Dr. Pravin Kumar Bharti is the Deputy Chief Medical Officer and Nodal Urban Health with the National Urban Health Mission (NUHM) in Mathura (Uttar Pradesh, India). He has six years of experience across a wide spectrum of urban health issues. He recently sat down with The Challenge Initiative for Healthy Cities (TCIHC) to share his experience with TCIHC and TCI University (TCI-U). TCI-U includes an India toolkit, which has codified high-impact approaches (HIAs). These approaches are being scaled up through TCIHC in three states: Uttar Pradesh, Madhya Pradesh and Odisha. The India toolkit features 15 HIAs, which strengthen service delivery and supply, demand generation and advocacy components of family planning and adolescent and youth sexual and reproductive health (AYSRH) interventions. The toolkit provides standardized and contextualized information, resources and 'how-to-do' guidance, which can be easily customized to meet the city requirements for rapidly scaling up evidence-based family planning and AYSRH interventions. In 2019, the government of Uttar Pradesh, Madhya Pradesh and Odisha endorsed and approved the high impact approaches and tools of TCIHC, expanding the reach and ultimately impact of them. 

When did you first learn about TCIHC and TCI-U?

In February 2019, TCIHC had organized a State Conclave where the state of Uttar Pradesh endorsed nine HIAs [high-impact approaches] of TCIHC. This is where I first learned about TCI-U. At that time, I was holding the position of District In-Charge, Control Room, Mathura. As a result of my interest in family planning and urban health, I was nominated by CMO [Chief Medical Officer], Mathura, to participate in the State Conclave. As soon as I returned [from the State Conclave], I registered myself and my colleagues on TCI-U with the support of TCIHC City Manager."

What motivated you to first use TCI-U?

I developed a keen interest in TCI-U when during a meeting in March 2019 with the Chief Medical Officer, he required some job-aids related to Accredited Social Health Activists (ASHA) and he asked TCIHC City Manager for support. TCIHC City Manager quickly browsed TCI-U and downloaded the required information from the resource section linked to the HIA [high impact approach] on Urban ASHAs. I was impressed. And, from that day onwards, I have kept hard copies of the HIAs on my desk and access them on TCI-U as well."

How have you used TCI-U?

The high impact tools have helped my department understand fixed day static/family planning day (FDS) approach, role of Mahila Arogya Samiti in demand generation for family planning, importance of convergence between various departments for improving family planning indicators, use of family planning data, funds allocated under Program Implementation Plan (PIP), etc. Moreover, I have downloaded government approved materials like - 'All method poster' from TCI-U; this poster is now displayed in all Urban Primary Health Centers of Mathura. Even this poster is used on FDS days and routine service days as well in Outreach Camps to counsel clients on family planning methods. I have also downloaded the 'Pregnancy screening checklist,' which was given to staff nurses and community health workers to identify potential clients. TCI-U has helped me improve family planning practices across cadres, including NUHM [National Urban Health Mission] staff to field-level workers. I also navigate TCI-U to learn other countries' innovations and ideas also."

What are your overall impressions of TCI-U?

Urban family planning requires a lot of innovations and TCI-U is one such platform that provides innovative proven approaches. I like everything about TCI-U because it helps to understand our roles better, provides ways to get quick results and offers solutions to overcome potential challenges. That it is my job to improve family planning indicators and take decisions. TCI-U helps me do that. I have taken a couple of assessments related to the HIAs and earned certificates, which I find to be the most exciting part. TCI-U is a well-structured website, which provides comprehensive information and resource materials."

Like Dr. Bharti, around 35 government officials are registered on TCI-U from Mathura and most of them have completed the assessments for the high-impact approaches and received certificates.

For reading this story on TCI University please https://tciurbanhealth.org/in-their-own-words-nuhm-deputy-cmo-in-mathura-likes-innovations-found-in-tci-university/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

TCIHC Helps Local Government Address Staffing Shortages During COVID-19 to Ensure Family Planning Service Delivery
As a result of the COVID-19 pandemic, city governments are faced with numerous management and operational challenges in  meeting the family planning needs of the urban poor. These challenges are compounded by shortages of service providers in urban primary health centers (UPHCs) as several staff were moved to district hospitals for COVID care duties and a large percentage of providers were infected with coronavirus and/or quarantined due to exposure. In cities supported by The Challenge Initiative for Healthy Cities (TCIHC), such as Shahjahanpur and Mathura, city governments have resolved these operational challenges through the use of TCIHC's high-impact approaches to ensure family planning service delivery resumed during the COVID pandemic. 

Shahjahanpur's city government used the city coordination committee (CCC), a convergence platform, to address a lack of service providers at UPHCs, while the city of Mathura harnessed the capabilities of Quality Improvement (QI) committees at UPHCs to resolve issues arising from staffing shortages. Both CCC and QI are part of TCIHC's high-impact approaches: Convergence of Services and Quality Assurance, respectively.

Dr. Laxman Singh, Additional Chief Medical Officer (ACMO) and District Immunization Officer (DIO) of Shahjahanpur shared how he used the CCC approach to address staffing shortages and reopen the UPHCs of the city:

"COVID-19 pandemic adversely affected family planning services in Shahjahanpur. All 10 UPHCs staff were engaged in COVID-19 care and management duties [as a result of government mandate's]; hence, all UPHCs were closed. This affected provisioning of all health services, including family planning services. However, Accredited Social Health Activists (ASHAs) were distributing oral contraceptive pills (OCPs) and condoms in the community during their COVID-19 survey, but clinical family planning services had almost stopped due to unavailability of service providers and this was the biggest concern for us. I shared this concern with TCIHC who coached me to refer to the 'Convergence' approach. I discussed this with my team, including the urban nodal officer and urban health coordinator, and we organized a CCC meeting in September 2020. In that meeting, Nagar Swasthya Adhikari [the municipal officer of health] raised the same concern of non-availability of service providers at the UPHCs. Thus, this committee decided to shift the task of service delivery to trained Auxiliary Nurse Midwives (ANMs). It was decided that, except for immunization day, ANMs will provide health services in UPHCs, including IUCD and Antara services, in routine days and during Antral diwas [Fixed-day static services for spacing methods]. Soon after the CCC meeting, we developed a plan and ANMs were allotted to UPHCs. UPHC staff involved in COVID-19 duty were, however, directed to be present at their respective UPHCs on Antral diwas. In this manner, we were able to reopen all 10 UPHCs and provided method choices to family planning clients. The convergence tool of TCIHC helped us in coping with this challenging situation during the pandemic."

Punish Kumar, the Urban Health Coordinator of Shahjahanpur, shared how the government of Shahjahanpur plans to continue implementing this approach since they have witnessed its success, especially during these trying times:

With the technical support of TCIHC, we initiated CCC meetings in Shahjahanpur. So far, this collaborative platform has helped NUHM [National Urban Health Mission] department to collectively work and plan with all urban stakeholders and resolve issues pertaining to urban family planning. During the challenging time of COVID-19, the CCC platform helped us to restart family planning services, including Antara and IUCD services in UPHCs, to meet the family planning needs of the urban poor. We are confident by utilizing this platform we can manage any disaster situation in future also."

Dealing with the same challenge - a shortage of providers at UPHCs to continue family planning services - the city of Mathura encouraged UPHCs to conduct QI committee meetings, where UPHC staff meet and identify solutions to challenges. Jeetendra Singh, a Pharmacist at the Laxmi Nagar UPHC in Mathura and a QI committee member, shared how this meeting played an instrumental role in overcoming this challenge:

The staff nurse of our UPHC was engaged in COVID duty because of which family planning service provision was completely stopped. Many IUCD and Antara clients who visited Laxmi Nagar UPHC on Antral diwas had to return without availing services. This issue was raised in a QI committee meeting. This concern was realized prior to this meeting also and was discussed with TCIHC and they had coached us about the guideline issued by the state government for reinitiating Antral diwas, which stated that in the absence of service providers, trained ANMs can provide services on Antral diwas. The coaching I received helped me present this solution at the QI meeting. This recommendation was accepted, and I felt proud that I could give this suggestion based on TCIHC's coaching. Soon, a government order was issued and a trained ANM was assigned to Laxmi Nagar UPHC and, with her support, we were able to reinitiate family planning services, including long-acting reversible methods during Antral diwas. This step has ensured that none of the clients return home without availing family planning services at least on FDS/Antral diwas days."

The Antral diwas state directive was an outcome of rigorous advocacy efforts of TCIHC's Uttar Pradesh (UP) state team and was issued for all 75 districts, including both urban and rural, to ensure family planning services resume and do not lose momentum gained in addressing the unmet need for family planning in UP.

Dr. Man Pal Singh, Nodal Officer of NUHM of Mathura, highlighted the contribution of the QI committee meeting not only in resolving this issue but in addressing other quality-related issues and gaps:

Many times, we came to know about issues and challenges at UPHCs through QI committee meetings. TCIHC played a major role in institutionalization of QI committee meeting concept at the UPHC level. We started QI committee formation and meeting with the technical support of TCIHC. These meeting help UPHC staff to periodically discuss quality related issues, gaps and find solutions. Laxmi Nagar UPHC staff raised the issue of staff crunch in QI committee meeting, which was hindering family planning services. They then proposed a solution, citing the Antral diwas directive to assign trained ANMs on FDS days at UPHCs. We immediately referred to the mentioned state directive and decided to assign trained ANMs at UPHCs. This decision helped us to resolve this similar issue for all seven UPHCs [across Mathura]. We prepared duty roster of each ANM and, on rotation basis, ANMs started providing family planning services, including IUCD and Antara services in Antral diwas. We also decided that if Antral diwas falls on a holiday then the next working day in the same week is allocated for the Antral diwas. This way we are able to fulfil the family planning needs of the urban poor during the pandemic, as once again they can get family planning services of their choice from their nearest UPHC. Apart from this, I regularly review data with my Data Cum Account Assistance who has been coached on data management by TCIHC and as a result, I am able to see the progress made by all the UPHCs on family planning indicators and other services as well."

Archana Gaur, ANM, Laxmi Nagar UPHC also shared her experience taking on more of a role in family planning service provision during the COVID pandemic:

I am providing family planning services in Laxmi Nagar UPHC. I was given this task because I am trained in IUCD insertion and dispensing Antara injectable. COVID-19 has affected everyone's life, especially the poor who are facing many challenges. I am happy that during the pandemic I am able to serve poor women who need IUCD and Antara services."

After the government-imposed lockdown, these evidence-based approaches have helped many city governments in UP to reactivate UPHCs to deliver accessible, quality and assured family planning services to the urban poor. However, city governments continue to face challenges related to demand generation as client visits for clinical services remain low as people are worried about becoming exposed to COVID-19 and refraining from leaving their homes unless absolutely essential.

For reading this story on TCI University please https://tciurbanhealth.org/tcihc-helps-local-government-address-staffing-shortages-during-covid-19-to-ensure-family-planning-service-delivery/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

TCIHC’s QA Approach Leads to National Recognition for Behrampur’s UPHCs
Quality assurance (QA) is one of the nine high-impact family planning approaches that The Challenge Initiative for Healthy Cities (TCIHC) uses when working with city governments. TCIHC provides technical support to urban primary health centres (UPHCs) to establish quality improvement committees, conduct a periodic quality assessment using a simplified checklist, develop and monitor a plan of action and ultimately be certified by the district quality assurance team for offering quality services. 

After TCIHC partnered with the City Health Department in Berhampur, Odisha, to implement the QA approach in all seven of its UPHCs, quality measures improved significantly. This improved quality was recognized nationally with all seven TCIHC-supported UPHCs of Berhampur earning the Kayakalp Award.

In 2019-2020, all seven TCIHC-supported UPHCs of Berhampur earned a Kayakalp award. Three UPHCs received first place and two others were recognized as runners up while the remaining UPHCs received a commendation award. Kayakalp Awards are a national initiative launched in 2015 to improve and promote the cleanliness, hygiene, waste management and infection control practices in public health care facilities and incentivize high-performing facilities.

Mr. Lamodar Digal, City Program Manager In-charge, National Health Mission (NHM) Berhampur, shared why this recognition is significant:

All seven UPHCs of the city achieved Kayakalp Award in 2019 as they followed QA guidelines, which improved the quality aspects of service delivery including hygiene, infection control mechanism and supported UPHCs in internal facility assessment. This is significant because in 2017-18 UPHCs were new. There were barriers related to biomedical waste management, training of staff on quality parameters and most of all since NUHM [National Urban Health Mission] was new, no other department took ownership [of quality assurance]. At this time, TCIHC worked with the city health team and actually gave shape to the vision of the Commissioner of Berhampur who wanted to 'Make UPHCs the first choice of treatment for people" of Berhampur and wanted them to qualify for the highest certification of quality, which is 'Kayakalp' and National Quality Assurance Standards (NQAS)."

In 2017-18, UPHCs provided only oral contraceptive pills and service providers, while Auxiliary Nurse Midwifes (ANMs), staff nurses and Accredited Social Health Activists (ASHAs), were unaware of the full array of method choices and were not trained to provide them. TCIHC helped coach ASHAs on counseling techniques, organized hands-on trainings of ANMs on all method choices, and ensured staff nurses received training on the provision of intra-uterine contraceptive device (IUCD) and the injectable contraceptive Antara. As a result of these efforts, family planning became an integral part of the services provided at the UPHC. Digal said TCIHC support made the difference.

Before TCIHC's technical support, we did not even imagine that one day we would be able to provide expanded choices of family planning, including long-acting reversible methods at UPHC."

But expanding the availability of IUCDs and injectables made quality a more prominent concern. As a result, TCIHC began supporting the quality assurance approach by having field program service assistants (FPSA) - who coach UPHC staff - incorporate family planning in the quality improvement meeting at UPHCs and district quality assurance committee (DQAC) meetings at the district level. This particular step not only prioritized issues in family planning but also helped uncover many other gaps related to quality, infrastructure, supplies, etc. These issues were discussed during DQAC meetings as well. The support also included the introduction of a simple checklist for family planning based on the NQAS guidelines. This simple checklist helped UPHC staff to self-monitor quality parameters. In addition, each UPHC in Berhampur created a family planning corner, which provided privacy for family planning counseling and services.

As a result of these measures, family planning was strengthened at each UPHC and this contributed to increased scores for both Kayakalp and NQAS and eventually helped each UPHC win both. Digal explained the mindset shifts that the QA approach has sparked at the UPHCs and among the communities that they serve:

Our UPHCs are now 'AMA clinic' (meaning 'Our Own Clinic') in the real sense. 'AMA clinic' was the slogan given by the Berhampur Municipal Corporation (BeMC), but it turned into a reality once we, the city government, got TCIHC's technical support. Our people around UPHCs are happy as there is no need to go to the district hospital or higher level hospital for primary health services, including family planning."

These QA measures of Berhampur inspired several cities in Odisha and the neighboring state of Madhya Pradesh to visit Berhampur UPHCs to learn more. Two more cities supported by TCIHC - Rourkela and Puri - also won Kayakalp commendation awards, thus validating that the right family planning approach can help a UPHC score for Kayakalp award. In addition, since TCIHC's inception in 2017, all seven UPHCs of Berhampur have increased the availability of all family planning choices for the urban poor population, especially reversible methods, such as IUCD, injectable contraceptive and non-hormonal pills.

For reading this story on TCI University please https://tciurbanhealth.org/tcihcs-qa-approach-leads-to-national-recognition-for-behrampurs-uphcs/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

Reaching First-Time Parents in the TCIHC-Supported Youth-Friendly Cities of Uttar Pradesh
The Challenge Initiative for Healthy Cities (TCIHC) in India worked strategically through its adolescent and youth sexual and  reproductive health (AYSRH) program to reach first-time parents with informed-choice counseling and modern contraceptive services over a six-month period ending June 2019 in five cities in Uttar Pradesh (Allahabad, Firozabad, Gorakhpur, Saharanpur and Varanasi). 

The first step was to make sure young first-time parents were visible, so they can receive appropriate services, including contraception, so TCIHC coached and mentored active urban Accredited Social Health Activists (ASHAs) to identify them from their urban health index registers (UHIR). This effort included coaching to make sure the ASHAs knew how to complete their UHIRs, develop lists of women based on age and parity (i.e., number of children), and devise a priority list of young first-time parents. At the same time, TCIHC worked to overcome provider bias to ensure providers and facility staff were aware of the latest medical guidelines and had accurate knowledge on all the methods available for young first time-parents at both the facility (medical-officer-in-charge and staff nurse) and community level (ASHA worker). "

Studies have shown that low parity can be a barrier to accessing some family planning methods. Data from the Urban Reproductive Health Initiative (URHI) found that 90% of the providers restricted access to female sterilization and intrauterine contraceptive device (IUCD) based on the number of children that a client has. Of this, 65% of doctors required a client to at least have one child and 63% of all traditional birth attendants believed that a woman can opt for an IUCD only if she had two children or more. As a result, a plan was devised to conduct whole site orientation (WSO) - a TCIHC proven approach - on adolescent-friendly services at urban primary health centers (UPHCs) in the five cities. Following this, the TCIHC team garnered support from city health teams to organize special fixed day static (FDS) services - another TCIHC proven approach - for first-time parents. These efforts significantly increased contraceptive uptake among first-time parents, aged 15-24, as illustrated in Figure 1. Forty-one percent of all women aged 15-24 accepting a family planning method at a UPHC were first-time parents, across the five TCI AYSRH cities, as compared with 28% in the 26 TCIHC-supported cities implementing TCI's proven family planning solutions in Uttar Pradesh, Madhya Pradesh and Odisha with no special focus on AYSRH.

Upon learning about the AYSRH impact, many of the TCI cities implementing family planning only informally began adding AYSRH activities. As a result, these cities also began to exhibit increased results in reaching women 15-24 years and referring them to FDS (Figure 2). While TCIHC AYSRH cities still reached more young women, ages 20-24, (50.3%) than TCI family planning only cities (42%), the fact that there is not a large gap between the two different city groups speaks to the scalability of the AYSRH approaches.

For reading this story on TCI University please https://tciurbanhealth.org/reaching-first-time-parents-in-the-tcihc-supported-youth-friendly-cities-of-uttar-pradesh/

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

 
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