Bureaucrats with multiple superiors often encounter difficulty in implementing policies initiated from higher-level officials. When there is a lack of policy-making co-ordination among the superior bureaucrats, the result can be conflicting and excessive policy demands made on the subordinate implementors. Problems caused by such demands are likely to affect adversely the work performance of these subordinates. As noted in a previous study, it is difficult to achieve policy co ordination among the superiors because of the political nature of the provincial bureaucracy of the Ministry of Public Health (MOPH).1 Public health officials within each province form political cliques which compete with each other for power and influence. At the same time, the work of superiors, both at the district and provincial levels, are functionally differentiated. Each superior has a tendency to over emphasize the significance of his work at the expense of others. Con sequently, each superior usually demands that subordinates at health centres give first priority to his functional area. In recent years, the MOPH has often changed its policy goals and guidelines. This has created a situation of policy ambiguity. Many superiors and subordinates alike do not comprehend the new policies originating in Bangkok. They are not certain what the policy priorities are, and sometimes do not take these policies seriously because they know from experience that the MOPH will soon initiate a new set. Recently, the MOPH made another major policy change. Accord ing to the Fifth National Public Health Plan, and in accordance with the Fifth National Socio-Economic Development Plan of Thailand (1982-86), the new overall objective of the MOPH is to promote primary health-care throughout the country. The target is to improve the health conditions of the poor in rural areas. This article will address the possible implications of this new