PIP: Tanzania stresses primary health care as evidenced by its shift away from hospitals to health centers, which have outreach programs thereby increasing access to health care in rural areas. Each health center services about 50,000 people in a radius of 10 km. Medical assistants manage most health centers. They are responsible for not only administration an operations of the centers but also from health promotion and disease prevention and curative activities. Health promotion/disease prevention efforts center around involving local people in decisions about what must be done to meet health needs and about solving health problems. Curative activities include patient examinations, diagnoses, prescription of treatment, and some minor surgery. These responsibilities alone are considerable, but medical assistants must also conduct short and long term planning, organize activities, handle crises (e.g. epidemics), manage resources, and ensure effective health care in generally inadequate facilities. The last mentioned responsibility requires them to supervise, guide, and support staff while instilling teamwork and to oversee that health data are recorded and reported to the authorities. Despite this considerable management role, medical assistant training stresses diseases and treatment. Accordingly, they tend to care for patients rather than manage the health center. Lack of motivation and restlessness permeate throughout the health center team. An operational study is needed to identify the basis for the lack of drive and restlessness in health centers and possible solutions to improve the situation. The study should include questions on medical assistant training, resource allocation, and support of the community and of the local and district governments.