Christine has been the nurse in charge for Kilifi sub-county, Kenya for the past 15 years, playing a key role in Kenya’s public health system. Her supportive supervision, drive, and tireless dedication to ensure that basic care is available to those who cannot afford access to private care is a source of inspiration in her community. Many low and middle income countries have been decentralising their services from central governments and large hospitals to local governments and district health clinics. This process has been promoted for its potential to improve efficiency, responsiveness and local accountability. In practice if and how this works is highly shaped by the decisions and actions of managers at the district level; a role that is often under-recognised and that Christine has taken on at different levels.