District health systems (DHS) are central to
the global efforts to improve health outcomes
but many remain ineffective. In many low-
resource settings, despite the generally weak
DHS there is evidence that some districts con-
sistently perform well against the odds, and
this is often attributed to the calibre of man-
agers leading such districts and their manage-
ment and leadership (M&L) skills. This paper
examines the M&L practices of district health
managers in high and low performing districts
in Indonesia in an attempt to understand
whether the differences in the performance of
DHS can be explained, at least in part, by the
differences in the performance of their health
managers. We employed a mixed methods case
study design focusing on two purposefully
selected districts. Data were collected in 2011
using questionnaires and in-depth interviews.
The preliminary results suggest that M&L
practices of managers in the high and low per-
forming districts are similar and provide little
explanation for the differences in the perform-
ance of the two DHS. Contextual and health
system factors offered a much better explana-
tion for the variations in DHS performance.