In recent years, the governance of the health system has become a key issue of discussion for international organisations such as the WHO, the WB, UNDP, USAID and the EC. Furthermore, they state that spending on health would not alone achieve the intended results in health without addressing governance. The study aims to recommend specific strategies to strengthen governance of the DHA in Bihar. In doing so, it first identifies and critically analyses the causes of poor governance. Moreover, it reviews theories and documented effective examples of strengthening governance in the district level health systems in low and middle income countries. The study finally analyses various strategies for strengthening governance and outlines appropriate governance for the DHA. To undertake this study, a framework developed by Brinkerhoff et al. (2008) is used, which covers leadership and management capacity, accountability, community participation and transparency in decision making. The methodology primarily involves reviewing secondary data, however, a number of health and development professionals were contacted to obtain a number of practical experiences.