This paper is concerned with competencies and skills that enhance the capacity of health service managers to handle changes that medical technology and other factors have brought about. The paper takes a strategic rather than an all encompassing approach to identify the systemic changes that have taken place in the last decade. Statistical analysis and other information available were used in this process. One of the reasons for this approach is to take a real-world perspective of contemporary health management issues as the underpinning of the research. The salient systemic changes identified are classified under three major categories: practice evolution, service capacity and inputs and structural changes in public sector administration. The methodology involves a framework that led from systemic changes to related management issues and thence to competencies and skills of relevance. The latter relied on the inventory of health service management competencies and skills identified by academic research. The framework structure took into account the competence/skill domain and context. It led to groups of predisposing, enabling and transforming competencies and skills related to the management issues arising from the systemic changes identified. The findings will help examine strengths of current post-graduate courses in health service management. They also provide an agenda and opportunities for continuing education by relevant professional organisations.