In this investigation of management at the peripheral level, multiple interviews were conducted by a team of five people in 14% of the primary health care villages in The Gambia. The investigators sought to understand principles of village social organization and the process of political factionalism that sometimes disrupts health programmes. A methodology was developed for investigating the structure and function of communities, for use in the health planning and re-planning process, especially where considerable community participation is desired. The methodology uses both qualitative and quantitative types of data collection and analysis. Both historical description and present-time systems analysis are used. Gambian villages are organized on principles of caste, class, age, religion, gender and ranked order of wives. The resulting stratification contributes to political factionalism. Major political institutions include the headman and his council, the women's organization and newly created village development committees. Villages that have successful health programmes are compared with those that do not on a set of eight variables, and recommendations to improve the function of primary health care are made.