This article considers the challenges which impede the efficient and effective implementation of healthcare governance structures in the North West Province of South Africa. The discussions focus on the understanding of healthcare problems. Furthermore, the challenges that existed when implementing the healthcare governance structures to ensure that there is improvement in the manner in which healthcare delivery is undertaken in the North West Province receives attention. Recent strikes and protests against the North West Provincial government are a testimony that the healthcare governance issues are now critical in provincial administration than before. The aim of this article is to examine the challenges of implementing health governance structures in the North West Province of South Africa. In the final conclusion, the discussions in this article point to the need to build some basic understanding on healthcare governance issues,