The article describes the developmental stages of a health care project from the inception as a demonstration project until its establishment as a large scale national program. The skills and competencies required of a project administrator during the demonstration stage are more related to the practice of community organization. However, in expanding a demonstration project to a large scale national program, these administrators are confronted with a multitude of bureaucratic and organizational constraints. The skills and competencies required of a program manager at this stage are best grouped under the field of organizational development. The failure of many large programs can be traced to the lack of organizational development skills among those involved in managing them. The implications for organizational development training within the curriculum of instruction in health education are also discussed.