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The objective of this research is to evaluate Human Resources managerial/development effectiveness (HRM/DE) of frontline managers from the perspectives of managers themselves and stakeholders in the public health sector (PHS) of Ghana. The study did this through the development of a conceptual framework which combined the use of integrated organisational and management theoretical perspectives and contextual variables. The study employed the mixed methods research methodology which combined both empiricism and post post-positivists' views with critical realism as the underpinning philosophy. A total of 18 district directors of health, from two regions were purposively sampled and interviewed utilising an in-depth open ended questionnaire through the discussion. Additionally, key policy makers were interviewed and focus group discussions held and a structured questionnaire completed by another group of employees, who assessed managers' capabilities. Discourse analysis was used for the analysis with the aid of Nvivo 7 for the qualitative material whilst quantitative data were analysed using simple descriptive statistics. Findings were triangulated using Marquart and Zercher's (2000) cross-over track analysis framework. Findings show research questions were answered. Majority of district directors lack managerial competencies; are less interested in HRM/D activities, less confident of their human resource skills and less sure of the political and representational skills required of managers. In particular, it is necessary to take account of the political structure of the PHS of Ghana; significant differences exist in power, individual or group interests, values, assumptions and expectations. However, most district directors have tried to indigenise HRM/D practices as a way of motivating and retaining staff. Core Human resources managerial competencies from the perspectives of the three sampled groups have been compiled. It is the first time such a study has been conducted in the PHS of Ghana and which has therefore made inroads in the existing literature and has contributed to HRM/D literature information in Africa particularly Ghana. It also paves the way for understanding management in the African context and perspective and specifically in health care settings. This study has gone beyond the two groups of respondents and proved that the use of multiple respondents generates rich findings and unveiled what would normally have not been possible if single respondents were used.