Many districts and cities in Indonesia continue to have Public Health Development Index scores below the national average, highlighting the need for improved health governance. This study assessed the five-year impact (2019–2023) of a mentoring program for 149 District Health Offices in preparing annual work plans, focusing on stagnation or performance declines. Using a qualitative approach, the study analyzed annual work plan scores before and after technical assistance, conducted focus group discussions, and carried out in-depth interviews to identify challenges. Key barriers included data management issues, weak advocacy, knowledge transfer gaps, and poor cross-sectoral coordination, which hindered decision-making and program sustainability. Findings suggested that structured technical assistance enhanced data-driven planning and intersectoral collaboration at the district level. Strengthening governance frameworks through capacity-building programs and integrating mentorship models into national health strategies can improve regional health performance. Copyright @ 2025, Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)