Case studies were undertaken in three countries in Africa, namely Ethiopia, Ghana and the United Republic of Tanzania, to explore the availability and training of health service managers, especially those at operational levels. In the United Republic of Tanzania, the study was carried out separately in both the mainland and Zanzibar. For the ease of reference, hereafter, mainland data is referred to as for the United Republic of Tanzania (mainland) and the parts specific to Zanzibar mentioned as such. This report presents a summary of the findings from the three country case studies.

The first part of the paper covers the objectives and rationale for the studies and discusses a WHO conceptual framework on which the analysis is based. The second part examines the context and background of the study countries and the factors that influenced their approach to health services management. The third part describes the study's methodology and the fourth part presents and discusses the key findings. The report concludes with a discussion of the practical implications of the management situation for the countries and makes recommendations.