Abstract Background : Lower-level community health centres play a crucial role in the delivery of primary healthcare services, and the competences of their leaders can significantly influence district health performance. Objective : The study assessed the influence of competences of lower community health centre leaders in annual health work planning on the district performance improvement. Staffs are recruited based on staffing standards and expected to participate in district health planning cycles, and use implementation manuals in developing annual health work plans to improve district health performance. Methods : A retrospective (case control) study design was employed to understand health centre performance data across various districts in the Busoga sub-region. There was a comparison of performance between the worst performing (case) and best performing (control) districts in the region according to the Annual Health Sector Performance reports from 2017/18 financial year to 2021/2022.  Statistical analysis of data from 12 health centres in the case and 12 in the control was conducted using STATA version 16 to determine competences of lower community health centre leaders that influence district performance. Results : The study found that the district performance in annual health work planning was not good in both the case and control groups (26.4% and 47.2% respectively). Only three competences variables were statistically significantly associated with improved district health performance. Health centres that (1) met staffing levels in accordance with public facility standards (χ2, 7.756; p-value, 0.005*), (2) staff attended district planning cycle meetings (χ2, 16.713; p-value, 0.001*), and (3) health centres utilized four or more implementation manuals for the development of their annual health work plans (χ2, 43.333; p-value, 0.001*) demonstrated statistically significant improvements in performance. These competences enabled more effective service delivery, better alignment with district health priorities, and the implementation of comprehensive, evidence-based interventions. Conclusion : The competences of lower community health centre leaders is held together with health centres meeting staffing standards, their participation in district planning cycles, and the utilization of implementation manuals and are critical for improving district health performance in the Busoga sub-region. Strengthening these competences through targeted supportive meetings and capacity-building initiatives is recommended to enhance the overall effectiveness of health service delivery at the district level.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval to conduct the study was provided by the Institutional Review Boards (IRB) of Uganda Martyrs University – Nsambya hospital (SFHN — 2024 – 134).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

data will be available on request