In 1987, as a result of an interregional conference of the WHO in Zimbabwe, a number of countries and actors committed themselves to adopt the district health system strategy in order to reinforce the Primary Health Care. This way the Declaration of Harare was born. 25 years later, the African health systems, especially in rural areas, have undeniably made progress what the structure and coherence is concerned. The district health strategy has played a key role in this respect. This being said, the strategy of the health district has also revealed certain weaknesses and has not necessarily been able to draw attention to all difficulties typical of these contexts, to the shortage of resources, or to certain structural weaknesses of the States. It seems to be appropriate to draw up the balance sheet, but it is more essential to make an update of the approach of “health districts” in Africa. The conference will gather more than 100 experts, including district managers, clinicians, policy makers, public health specialists, researchers, technical assistants, representatives of NGOs and the civil society as well as socio-community actors.