<![CDATA[The implementation of organizational structure and work procedure policies is essential to support effective regional health services. Ministry of Health of the Republic of Indonesia issued Ministerial Regulation No. 21 of 2024 as part of national health system reform and transformation. However, its regional implementation still faces various challenges. This study aims to analyze the implementation of Ministerial Regulation No. 21 of 2024 at Health Office of South Bengkulu Regency and identify supporting and inhibiting factors. This study used a qualitative approach with a case study design. Informants were purposively selected, including leaders and staff involved in organizational structure and work procedures management. Data were collected through interviews, observation, and document review, then analyzed using the Miles and Huberman interactive model. The results show that the implementation of Ministerial Regulation No. 21 of 2024 at the Health Office of South Bengkulu Regency has not been optimal due to the absence of formal adjustments to organizational structure and work procedures. Main obstacles include uneven technical understanding, ineffective policy communication, limited human resources and budget, normative implementer disposition, and bureaucratic structures not yet aligned with national policies. The inconsistency between central and regional regulations has hindered comprehensive policy implementation. The study concludes that successful implementation of organizational structure and work procedure policies requires effective communication, adequate resources, implementer commitment, and alignment between central and regional regulations. This study recommends accelerating regional regulatory adjustments and strengthening government officials’ capacity to support more effective health governance.]]>
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