ABSTRACT
In urban areas there is usually a mix of providers offering various health services. There may be government services run by the local council, municipal council, state or central ministry; private hospitals, laboratories and practitioners; and a variety of nongovernment providers, including missions and charities. Given these complex circumstances, senior health managers have to decide exactly what the responsibilities of the state are in public health, and in ensuring access of urban populations to health services. Management and planning in urban health services requires skilled personnel at policy level capable of analyzing the current political, financial and policy factors; restructuring health service financing and management to increase efficiency; and making the best use of resources available. Most health managers are doctors, and the management demands on them go far beyond their capacities. Managers are required at lower levels in the system, at municipal and local levels.
