The International Conference on Population and Development (ICPD) urged nongovernmental organizations (NGOs) to work in partnership with governments to implement the ambitious 20 year Programme of Action (United Nations, 1994). At the same time, it also challenged civil society to participatein policymaking, program design, and implementation to ensure that local health care needs, including reproductive health needs, were met. Many countries in Latin America and the Caribbean (LAC), as elsewhere in the world, are implementing the ICPD Programme of Action in the context of health sector reform, which embraces a set of sweeping initiatives, including decentralization, theoretically designed to meet the health needs of communities (Hardee and Smith, 2000; McGreevey, 2000). The Programme of Action supported the trend toward decentralization by recommending that governments promote community participation in reproductive health services by decentralizing the management of public health programs and encouraging growth in the number of NGOs and private providers. The POLICY Project, a five year USAID funded project launched in 1995, incorporated the ICPD mandate to improve the policy environment for sexual and reproductive health through participation of civil society.