If you are the kind of person who listens to conservative advice, you may do okay in life, but you probably won't ever be a fantastic leader. You have to take risks, and you also have to go against conventional wisdom, because conventional wisdom doesn't make for startling advances in society.

When we conducted focus group interviews in the first municipality in Brazil before initiating the pilot project, a woman commented: Getting an appointment in the public sector municipal health services is like "winning the lottery." I would like to make it possible for many women and men in Latin America to win the lottery and receive the type of reproductive health services they so urgently need.

International "experts" from technical assistance agencies or universities can make important contributions, but they certainly don't have all the answers. When ownership is local and national, and various stakeholders work together, program innovations have a greater chance to take root and survive.

We felt that the Gates Foundation looked at our track record and our publications and decided that "this is persuasive; this needs to be done. Let's see what they can do."

Our practical purpose is to facilitate expansion of service innovations on a larger scale to improve access to, and the quality of reproductive health care. We are very grateful to have received support from the Bill and Melinda Gates Foundation to continue our work.

High level policy makers and program managers do not normally listen to the voices of local people, local providers and local program managers when they make decisions about contraceptive introduction or other aspects of program development in reproductive health.

I have been working with the World Health Organization since 1989 in an effort to redefine approaches to contraceptive introduction. This has given me the opportunity to insist that strategies for research and policy development must simultaneously address people's needs, the capacity of programs to provide good quality of care, and the range of technological options available.