Since 2001, Indonesia has entering its new era of democratization called decentralization in all sectors, including health. From now and then, the District Health Office has been forced to be able to implement its health policy and function such as 1) stewardship, 2) health resources management, 3) health financing, and 4) health services provision. Basic function of health system is needed to achieve the health purpose that shown the performance of the health offices and its structure. The performance is related to the quality of management. European Foundation for Quality Management (EFQM) is a tool to quantify and assess the quality of management in an institution, so that it will be understood what is the weakness and the strength of the institution. EFQM was developed in Europe that has been proved that it can formulate an excellent management and performance by then. This study implements the EFQM model towards performance improvement model development in district/municipality health office. The objective of the study is implement EFQM model in improving health system performance in district/municipality. Type of study is a health system research with a cross sectional design in three selected district health office based on Human Development Index criteria, that is high, medium and low. Analysis has been done implementing the EFQM method called RADAR. The study location were Tabanan district (Bali), Bandar Lampung Municipality (Lampung), and Belu District (East Nusa Tenggara). The qualitative analysis was quantified using the RADAR for the nine pillars in the method. The nine criteria were grouping into enables and results criteria, such as 1) enables criteria of leadership, policy and strategy, employment, partnership and resources as well as process; 2) results criteria were: clients satisfaction, staff satisfaction, social results of the community as well as the main key. Each criteria has some sub-criteria. Each sub-criteria then be valued using the RADAR, and quantified ranged from 0-10 as no prove and anecdote only; 15-35 as there are some prove; 40-60 as proved; 65-85 as strongly proved, and 90-100 as completely proved. The final evaluation of each pillars done by counting the average values of the sub-criteria multiplied by each weight of the pillars that already formatted. The formatted weight was 1.0 for the leadership; 0.8 for the policy and strategy, 0. 9 for the employment; 0. 9 for the resources and partnership; 1.4 for process; 2. 0 for clients satisfaction; 0. 9 for staffs satisfaction; 0.6 for community social satisfaction and the 1.5 for the key indicator, with a total weight of 10. Results showed that the final results of the health office performance were Tabanan has the highest of 250, Bandar Lampung Municipality 239, and Belu 217. This scoring seems directly reflects the management achievement level of District Health office that correlate to the HOI Index. The EFQM method can be used as a model to improve staff performance in the district health office by maintaining the weaknesses found in the field as constraints.