In conversations regarding health care in Jordan, it is not uncommon to contrast the under-utilization of private health services with the congestion found in public health care facilities. Occasional schemes are discussed that might tap this private sector resource in order to expand the health care offerings for the uninsured and indigent. Universal insurance coverage is a recurring example. In point of fact, public sector health facilities do refer patients to the private sector in certain specified instances such as acute cases that cannot be attended to by the public sector facility, or certain disease categories (notably carcinomas) where the public sector lacks the facilities, personnel, or resources to manage the case. In the areas of preventive and primary care there have been no reported instances where the public sector, specifically the MoH, has established a referral mechanism to the private sector.   CMS/Jordan was approached by the MCH Directorate of the MoH in February 2003 for assistance in resolving a service problem in the southern governorate of Aqaba. The MoH had, at that time, no female providers in the governorate who were trained in IUD insertion. CMS/Jordan research had shown that 75 percent of the women in the country would not accept IUD insertion from a male provider. That statistic, coupled with the great popularity of IUDs as a modern method (62 percent of all modern method coverage), signified a major barrier to service in the governorate. In light of these factors CMS/Jordan agreed to explore options for providing IUD insertion by female providers in the governorate. The most immediately apparent option was to direct prospective IUD adopters to female physicians in the private sector.   CMS/Jordan staff screened the private female providers in the governorate and found three private facilities with qualified female providers which were willing to provide IUD insertion at CMS/Jordan dictated prices: the JAFPP clinic, Jordan Red Crescent, and Dr. Manal Al-Rayan. Two midwives in each of the three MCH centers were trained by CMS staff in client screening and referral. At particular issue in the screening was the identification of women who were both poor and at high maternal risk; CMS/Jordan will pay doctors a set rate for contraceptive service for such women.   The program was straightforward. When a woman arrived at the MCH clinic for contraception, the midwife would inquire as to her preferred method. Methods not requiring vaginal examination were attended to in the clinic. If the woman, however, expressed interest in an IUD and had no evident contraindications, she would be told that such services were available in three private facilities. She would be given a referral slip and if she were high risk and indigent she would also receive a voucher for free IUD insertion and one free followup consultation.   On 10 April the referral program began and continued until 12 June €“ a period of nine weeks €“ on which date the MoH was able to offer IUD insertion from female providers.