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To improve effectiveness and efficiency of urban health services there is a need clearly to identify policies and the functions of various stakeholders and individuals in the system. System development, which involves, analysis of situations and the developing of solutions to address the identified issues, is necessary and forms a crucial element of system reforms. Developing systems in a participatory manner along with management capacity building can yield better results in terms of applicability of the system, improved confidence and ability of managers and service providers and sustainability of the reforms.

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