Impact of The Challenge Initiative on Public-Sector Family Planning Service Provision in Pakistan: Evidence from a Difference-in-Differences Analysis

Purpose: The study assesses the impact of The Challenge Initiative (TCI) on public sector provision of modern family planning (FP) services in 15 urban districts from two provinces of Pakistan. TCI partnered with the government's Departments of Health (DOH) and Population Welfare Department (PWD) for implementation of high-impact interventions. Patients and Methods: TCI began implementation in Punjab province in June 2022 and in Sindh province in September 2022. Monthly service data were obtained using the contraceptive Logistics Management Information System (cLMIS) from June 2020 to June 2025. Four districts were selected for the study: districts Rawalpindi (Intervention) and Gujrat (Control) from Punjab province and districts Malir (Intervention) and Sukkur (Control) from Sindh province. A difference-in-differences (DiD) analysis estimated the net effect of the intervention on average monthly family planning clients while interrupted time-series analysis (ITSA) assessed changes in trends before and after intervention. Results: DiD analysis showed a statistically significant overall effect of 3,673 clients (p < 0.01) relative to control districts across provinces and government departments. In the Department of Health (DOH), an estimated statistically significant net effect of 6,100 clients (p < 0.001). ITSA trends aligned with DiD findings, showing sustained increases in client volume in intervention districts compared to declining trends in controls. Conclusion: The study provides credible evidence on the positive impact of TCI on provision of modern family planning services using government departments' facilities and infrastructure. Findings across provinces and departments underpin the effectiveness of public-private partnerships in strengthening family planning service delivery in urban areas. Collectively, these findings provide a strong basis for institutionalization of TCI's high-impact interventions in provincial budgets, workplans, and policies.