Private and government organizations often face barriers and even failures in implementing strategic plans. Regional autonomy (local government reform) since 1999, it has not been properly translated by some regions and some components of this nation, so in its implementation there are many controversy and deviation. On the other hand, the challenge of globalization leads to a shift in the paradigm of an organization's superiority from comparative advantage to competitive advantage. Government organizations are no exception to be able to adopt this paradigm in order to provide optimal public services to the public. Government organizations need a new approach that is balanced scorecard in managing performance to achieve that goal and supporting the demands of bureaucratic reform. Thisstudy aims to analyze the implementation of performance management in realizing inclusive health with Balanced Scorecard approach at North Minahasa District Health Office. This type of research is explorative-descriptive through case studies using qualitative methods. This study uses primary data from interviews and observations and secondary data from the documentation. The results of research indicate that the process of development and implementation of balanced scorecard is done by cascading process from regional office of directorate general of health ministry to sub unit (subdit) to provincial health service office and finally to district health service office. This is also related to the policy of regional autonomy on the distribution of central andregional government arrangement. Achievement performance of North Minahasa District Health Office based on average value of achievement of main indicator of period 2010-2014 equal to 95,13% from target 100%. The average value of allocation and realization of APBD budget for the period of 2010-2014 amounted to 93.8%. In implementing Balanced Scorecard, the obstacles faced by North Minahasa District Health Office are lack of socialization and education about Balanced scorecard. Balanced scorecard is only integrated with reward system based on the achievement of organizational performance regardless of individual performance, has not developed balanced scorecard completely, has not made a strategic map, access to balanced scorecard application has not beenThe logical consequence of the health for all practice is in line with the principles underlying the implementation of regional autonomy that is justice, democracy and participation, efficiency and effectiveness.managed effectively and efficiently.