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This paper aims to describe the training strategy developed to provide the leadership of a new coordination structure of health centers in Portugal, with managerial competencies adapted to the requirements of their function, in support of primary care reform.

Pre and post‐program questionnaires were exploited. These focused on the perceptions of the new managers of their needs and of the benefits derived from their participation in learning activities during 2008 and 2009.

The findings outline that although the program created opportunities for executive directors to identify and analyze planning and management problems and to share potential solutions with colleagues, a training program is not sufficient to create the conditions that facilitate change.

More research is required to better understand the impact of the program on executive directors' attitudes and behaviors. More research on measuring the impact of leadership training is needed to provide policy‐makers with strategies to support their reforms.

The PACES training program was designed to develop and strengthen the managerial capacities of a group of managers of a new administrative structure in the health sector; it could be also applicable to other sectors like education, environment, etc.

If a reform process is to be effective, policy‐makers need to address, in addition to building individual capacities, organizational and institutional capacity needs, and design mechanisms to support managers on a continuing basis.

This paper describes the development of a new program focused on management and leadership to fit the needs of a reform in primary‐care.

The purpose of this paper is to present the results of a study to assess the capacity of a poor country to scale‐up its production of health workers.

The assessment consisted of a survey of institutions training doctors, nurses and technicians in Rwanda. Data on student intake, teaching staff, infrastructures and equipment were collected directly from the institutions by questionnaire administered in person. Data for the qualitative assessment of current and future capacity of production were collected by interviews.

Physical capacity in terms of classrooms and dormitories was generally good, except at the Faculty of Medicine. Laboratories and libraries were considered inadequate everywhere. Few national teachers hold a PhD and dependence on foreign trainers is high. Nursing teachers' training is also insufficient, particularly in pedagogy. As trainers are young, providing them with additional training should be easier. All institutions reported insufficient budgets. Managerial competencies are not developed. There is no licensing mechanism to ensure quality maintenance.

There is no validated data base on training institutions and the research had to rely on self‐reported statistics and other information.

A rapid increase in the production of health personnel would be difficult in the current conditions. Production strengthening should involve stakeholders from training institutions, and include measures to motivate and retain trainers, and to improve the quality of training.

The authors are not aware of similar studies in low income countries. Their methodology can be of interest to researchers and policy‐makers who do not have access to baseline data.

Publicly funded healthcare systems struggle to govern and determine how finite resources should be allocated in relation to political goals within a pre-determined budget. Primary healthcare (PHC) has a central multipurpose function, not least in terms of political strategies, but PHC governance is still largely underexplored. The aim is to explore how politicians responsible for making decisions pertaining to healthcare coverage navigate the governance of public PHC and disentangle it in the form of narratives based on different types of underlying rationales.

Semi-structured interviews were conducted with 15 politicians from 3 Swedish regional healthcare authorities. The data were analysed abductively based on scientific, clinical and cultural rationales using thematic content analysis.

Our study provides insights into how PHC’s multipurpose function implicates tensions between politicians' different responsibilities regarding healthcare coverage. It shows how politicians navigate various coexisting rationales, with some being more dominant than others and where tensions also exist between them. In this balancing act, they create narratives addressing different stakeholders and priority-setting dilemmas, reflecting the diverse rationales. Our study reveals that politicians play a crucial role in PHC governance and priorities, balancing rationales that might otherwise become overly dominant.

This paper contributes new knowledge by displaying how politicians balance tensions within and between rationales through different narratives regarding goals/commissions, problematic situations and preferred solutions in PHC governance.