I was intent on doing something productive and on being everything my parents taught me to be. Their values were clear: do good work; don't ever get too big for your breeches; always be an authentic person; don't worry too much about being famous and rich because that doesn't amount to too much.

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.

If 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.

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.

There are hundreds, even thousands of remarkable pilot or experimental projects in all fields - in agriculture, health, education. But where do these pilots take us? Do they lead to change on a broader scale? If not, how can we ensure that they have broader impact?

When ownership is local and national, and various stakeholders work together, program innovations have a greater chance to take root and survive.

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.