This article summarizes Uruguay's experience in local health systems development and the elements that have contributed to awareness and dissemination of this concept. In 1988 the Ministry of Public Health assumed responsibility as one of the entities charged with strengthening the country's local health systems. A technical group was created to act at the central level. It has proposed and promoted changes directed toward the deconcentration of resource utilization in accordance with a set of general guidelines and, at the local level, has acted as a catalyst in the understanding of health services delivery management as a systemic concept.