Diminishing financial resources and increasing demands for health care precipitated one public health district to review its framework of delivery of care for effective and efficient use of personnel and facilities. Categorical funding patterns had promoted a framework that functioned along specialized programmatic lines in which were identified inequities in funding and staffing, and use of services by clients. In addition, to the often inefficient use of staff and fragmentation of patient care were the associated consequences of overcrowded clinics, long waiting lists for appointments, and chronic understaffing of some clinics. The concept of cross-training in core services was initiated in one health center in October 1985. It was based on the belief that the best of generalized and specialized approaches to health care delivery in this district could be merged, and that all nursing staff should be proficient in certain basic functions. Results indicate improved efficiency in clinic management and flow, leading to reduced costs per patient encounter, increased demands for service that were met with existing staff, and reduced patient waiting time.