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Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2458/10/787/prepub doi:10.1186/1471-2458-10-787 Cite this article as: Marchal et al.: Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana). BMC Public Health 2010 10:787. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit