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The long term success of PNG's experiment with decentralization of health functions depends on the continued improvements in management at the operational levels of the health system. In 1986 the Department of Health initiated a management support programme for the intermediate level of the health system, which combined distance learning modules with periodic on-the-job consultation with provincial health managers. The initial results of this process have been encouraging. The primary challenge ahead, if this process is to succeed on a long term basis, is developing a means of institutionalizing the approach, identifying local resources to support the process, and developing the leadership that is necessary to it. This paper addresses the issues of maintaining and improving the management development programme.