Improving State Government's Responsiveness to Family Planning Interventions in Nigeria Using an Innovative Reflection and Action Tool

Background: The Challenge Initiative (TCI) works with state gov-ernments in Nigeria to scale high-impact family planning and re-productive health (FP/RH) interventions rapidly and sustainably. The Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool is an innovative responsive feedback (RF) mechanism developed by TCI to periodically monitor governments' readiness to sustain implementation of their FP/RH interventions. RAISE Description: The RAISE tool-a facilitated, self-administered tool used quarterly to track program improvements, identify gaps, and provide feedback-contains FP/RH progress indicators across 4 pillars: political and financial commitment, government capacity, institutionalization, and sustained demand. As a maturity matrix that helps state governments to understand the extent of their self-reliance in leadership and program management, the tool measures the stages of capacity: "beginning" (54% and below), "developing" (55-69%), "expanding" (70-84%), and "mature" (85% and above). Participants self-administer the tool with a trained government facili-tator, develop a remediation plan with timelines and responsible persons assigned to address identified gaps, and communicate the plan to the broader FP/RH program team. Assessment Results: Thirteen supported states have completed 5 rounds of assessments between June 2020 and September 2022. Baseline results revealed that 4 states were at the devel-oping stage, 8 were at the expanding stage, and 1 had a mature program. The most recent assessment revealed mature capacity for 9 states while the 4 others are in the expanding stage. Conse-quently, all the states demonstrated improved government self-reliance over the course of the year. Conclusion: To ensure objectivity, RAISE participants, who in-clude government policymakers, program managers, and imple-menters, use available government data sources to complement assessment findings. As an RF mechanism, the RAISE tool contrib-uted to governments' enhanced leadership and management of their FP/RH programs, with current considerations for modifica-tions to serve other primary health care programs.