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?

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.

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.

I came to understand the value of education, not just to enable me to make a good living, but to enable me to make a worthwhile life.

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.

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.

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.