With the implementation of primary health care policies the need for more effective management support at the intermediate or district level has become apparent, but experience is poorly documented. This article reviews the management experience of large‐scale district‐level projects in Ghana, India, Iran, Korea, Philippines, Thailand and Zaïre. The lessons point to a strong need to strengthen district‐level management and for greater decentralization. These in turn will require a review of the present organizational health structures and the strengthening of national‐level planning and management capacity.
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