We wanted to see how access to care can be expanded and service quality can be improved when one uses a participatory approach to program development. We showed that major changes become possible if you work in a participatory manner, listen to local people, diagnose what the problems are, provide training and identify where there are opportunities for mobilizing local resources to take action. In time leaders from other municipalities expressed interest in replication and the project succeeded in expanding innovations to three other areas.

It is not enough to give money for demonstration projects. From the very beginning plans should be made for the scaling-up of successful innovations.

A focus on people's health and well-being must be the core of family planning research and policy. This may seem self-evident, but the realities of program implementation in third world countries has often shown that the health and well-being of individuals is not a priority.

If you want to scale-up, the first thing you have to do is to expand your own team.

My colleagues from the Department of Health Behavior and Health Education are working on participatory public health initiatives in Michigan, and there is much that we can learn from each other. In fact it is essential that we strengthen efforts to learn from each other, and stop considering public health in the third world and in the U.S. as separate intellectual and practical endeavors.

It really pains me greatly to hear from graduate students that graduate education is a lower priority here.

Bureaucratic systems are not set up to be what we refer to as human service organizations. They were established to collect revenue and maintain law and order and they used a law and order approach in providing family planning services.