The results are summarized as pathways through configurations of factors leading to what are termed active and basic degrees of activity related to disease prevention and health promotion at the local level. The results raise considerations for policy-makers at each of the three levels of health systems regarding vertical and horizontal system structures, relationships to local government, management options and human resource incentives. The findings from this study can serve as a guide or menu of issues to consider in the implementation of new models of health care provision, not only in Brazil and Chile, but also elsewhere in Latin America and more widely in the world. Copyright (C) 2008 John Wiley & Sons, Ltd.