After the Republic of Kosovo's declaration of independence in 2008, new municipal structures were created with the charge of monitoring the delivery of health care services; yet, no mechanism for monitoring performance was ever implemented. With the public value theory as the foundation, the purpose of this multiple case study of 3 Kosovo municipalities was to understand issues surrounding the capacity of local government health department to monitor their performance related to the delivery of services. Relevant data were collected through focus-group discussions with 10 nurses, 9 directors of family medicine centers, and 12 municipal program managers. Purposeful semistructured interviews were conducted with 3 elected officials, 3 leaders of health care services, 3 policy leaders of relevant central-level ministries, and 9 participants from the national coalition of civil society organizations. All data were transcribed and coded per thematic analysis procedures. Results indicated that integrating the threefold value system of business value, social value, and governance value into municipal work plans and policy considerations will likely create a more solution-oriented service delivery at the municipal level. Furthermore, service delivery in the 3 municipalities appears to have improved over the past 5 years because of the pressure from active citizens, increased community engagement, and the institutionalization of home visits. Positive social change implications stemming from this study include the recommendation to central and local policy makers to fully integrate performance-based reporting systems into local legislation and policies. Such efforts can result in sustainable, equitable, and inclusive development, leading to stability and prosperity in Kosovo.