Effects of the Challenge Initiative's Community Health Volunteers (CHVs) on Public Sector Service Provision of Family Planning Services in Urban Sindh, Pakistan.

To counter the high unmet need for family planning in urban areas of Sindh province, Pakistan, Greenstar Social Marketing began implementation of The Challenge Initiative (TCI) in collaboration with the government departments of Population Welfare and Health in eight urban districts of Sindh province. This study aimed to assess the effectiveness of TCI's Community Health Volunteers (CHVs) on public sector service provision of family planning services in eight urban districts of Sindh province, Pakistan. The Contraceptive Logistics Management Information System (cLMIS) and District Health Information System 2 (DHIS2) were used to obtain monthly contraceptive data from June 2022 to December 2024. CHVs began implementation at different time points in each district, starting from January 2023 to October 2023, when CHVs became operational in all eight districts. Descriptive statistics and two-sample t-tests were used for data analysis. CHVs significantly improved family planning service provision, particularly for short- and long-acting methods at the facility level, with greater change observed in Department of Health facilities. This study provides preliminary evidence of the effectiveness of CHVs in increasing public sector service provision of contraceptives, particularly for Department of Health facilities. CHVs bridge the gap between the community and the facility, particularly in areas uncovered by the government's existing mobilization staff.