reported that using the Most Significant Change (MSC) technique had resulted in learning within and across countries to diffuse evidence-based interventions, as well as take concrete adaptive management actions.n Collecting significant change stories allows various voices and perspectives across the health system, from the community level to policy makers, to be captured about the impacts of programs, thus enabling prompt corrective actions.n Selection meeting discussions and responsive feedback about the significant change stories among various project stakeholders are critical for learning and collaboration.

The Challenge Initiative (TCI) Nigeria applied the Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool as a responsive feedback mechanism to enable all 13 state governments to assess their progress toward selfreliance in family planning/reproductive health programming; identify gaps; and incorporate learning and feedback to make improvements throughout the implementation life cycle. n Adaptation of the RAISE tool to Nigerian and state contexts improved local and state government teams' understanding of adaptive program management, leading to positive changes.

Institutionalization of pause and reflect (P&R) sessions as a responsive feedback (RF) mechanism within The Challenge Initiative project in Nigeria has contributed to improved program strategies and applicable lessons learned for replication by others scaling up evidence-based FP/RH interventions. n Initial challenges to institutionalizing P&R sessions can be addressed with advanced planning, use of an experienced facilitator, and application of RF reflections for adaptive management.

Strong external champions-both traditional and religious leaders but also media-savvy policy advocates-were a key component of a successful scaling experience by building public understanding and support for FP use and holding government leaders accountable for its provision. n Skilled and empowered state program officers, with support from internal government champions at the highest political but also agency leadership levels, spearheaded the introduction and implementation of the interventions and guided the institutionalization of interventions through existing state mechanisms.