PIP: During the past 10 years, the trend has been to decentralize health services in developing countries. In Papua New Guinea changes in attitude take a long time. The principles of a widely available service were set out in the 1974-78 National Health Plan. The 1986-90 plan reaffirmed them. The decentralized health service in Papua New Guinea is based on the type of administration that had existed in the Health Department. At the 1980 meeting of provincial health officers, the Secretary for the Western Highlands Department reported that services were not improving because of the skilled manpower shortage. He found that the national staff feared for their own status and ignored decentralization. They believed that it was a "passing phase." They refused to make decision, forcing responsibility on the provincial governments. The Secretary suggested that discipline should be broadened to include people affected. Many provincial health officers (PHO) were overseas contract workers, while headquarters staff were citizens of Papua New Guinea. Certain arguments against decentralization used by officials of the Papua New Guinea Department of Health were similar to arguments put forth by the New York City Health Department staff when decentralization was decided on in the mid-1970s. In late 1982, the situation started to improve in Papua New Guinea. In the provinces, all health workers tended to see themselves as members of a single team. The former PHOs became Assistant Secretaries (Health) for the provincial departments. A course in community health was introduced at the University of Papua New Guinea. A diploma is now necessary for those who want senior provincial health positions. Improvements in health occurred from the decentralized primary health care (PHC) approach. Infant mortality decreased from 134/1000 live births in 1971 to 72/1000 in 1980; childhood mortality decreased from 79/1000 to 42/1000. Life expectancy at birth rose from 47.4 years to 49.6 years. Maternal mortality apparently remained high. The population had improved access to health services. The coverage of disease control programs improved when PHC was introduced. To give more responsibility and power to the people is the basic purpose of decentralization.