Explores ways to improve the performance of health centres as a key component of efforts to strengthen district health systems based on primary health care and thus meet local needs for preventive as well as curative services. The role of health centres in overall strategies for health development is emphasized. Noting that health centres continue to perform poorly in most parts of the world, the report makes a special effort to identify factors responsible for the discrepancy between the great potential of health centres and the reality of their performance. Throughout the report, experiences from around the world are used to illustrate both the challenges faced and innovative ways of meeting them. The report has two parts. The first considers the role and functions of health centres and looks at the factors that influence their effectiveness. Issues discussed include political and legal frameworks, policies for management, the provision and training of staff, factors influencing the range and quality of services, and mechanisms for financing these services. Problems identified range from inadequate financial and logistic support, to the provision of services that are either of poor quality or inappropriate to local needs, from the paucity of data for planning and management, to poor and irregular salaries that undermine the commitment of staff. Against this background, the second section considers the radical changes needed to convert health centres from providing largely curative services to offering a comprehensive and dynamic primary health care programme. Four lines of activity are identified: defining the health centre's catchment area and developing a community profile, adopting a systematic approach to planning and implementation, generating the information needed to support health centre operations, and defining an active research and development agenda. The report then explains how each of these objectives can be achieved using a range of practical tools for generating information and using this information to improve planning, management, and services. The report concludes with an annex indicating the range of competencies and skills needed by staff in a properly functioning health centre.