If we succeed in learning more about how to expand program innovations from pilot projects so that they have broader program impact, this should be very relevant for public health initiatives in Michigan and elsewhere in the US.

It's very important in a leadership role not to place your ego at the foreground and not to judge everything in relationship to how your ego is fed.

A longer time perspective is needed because we face a daunting task both in an intellectual and practical sense.

In the late 60s, 70s and possibly early 80s, social scientists were interested in researching the diffusion of innovation and studying the link between applied research and policy and program development. Recently there has been less interest in these issues and we feel that this interest must be rekindled.

If instead policy makers and program managers participate in an interdisciplinary assessment team, make informal visits to local families and have in-depth conversations with local providers and health authorities, the real needs and complex challenges of organizing good reproductive health services become apparent.The first country that implemented this participatory program of assessment, research and policy development was Brazil. I was one of the outsiders who provided support to the initiative.

We have emphasized the importance of applied action research because it allows evidence-based policy and program development and a focus on learning. We are also committed to using a participatory approach in which local people, local program managers and providers, local researchers, women's health activists, and national decision-makers play the leading role. International "experts" from technical assistance agencies or universities can make important contributions, but they certainly don't have all the answers.

There is strong mentoring of women in the academy. Corporations appear more willing to resist affirmative action to advance women, and boards and shareholders are more tolerant of this approach.