'Tipping the balance towards primary health care': managing change at the local level.

This article addresses the problem of managing change at the local level, by focusing on the experience of the research and action project 'Tipping the Balance Towards Primary Health Care'. The experience of this project and case studies in other countries is abstracted. It includes some characteristics of the actors and forces under which local services operate, pointing to some opportunities and constraints in managing change and development, as well as organizational relationships in the field of primary health care. In this article it is argued that the ongoing structural reform is a necessary prerequisite, but it is not the unique key, for solving local health services problems. If the mission of the health sector is to satisfy the real and the perceived needs of the population, skilled professionals, appropriate technology, and enough financial resources must be allocated to the local level.