Provision of clinical health services at the district level can be achieved in most countries by expanding training programmes for primary care providers, particularly nurses and midwives; targeting construction funds to improve health posts, health centres and district hospitals; financing ambulances and other vehicles needed for effective emergency transport, together with the necessary radio and telephone networks; and building the capacity to plan and mange health services at the district level and in individual facilities. In many low-income countries, focusing on district health infrastructure will mean limiting new investment in central hospitals and reorienting those facilities toward research and teaching activities that are more relevant to key national health problems.