Abstract: Democratization in developing countries has been discussed whether it could enhance efficiency and effectiveness in public administration. In Indonesia, it has been implemented in the last decades but the ability of the local governance to enhance efficiency in public health services remain questioned. This study examines the association between democracy and efficiency in health service delivery.This study employed a mixed method design and was conducted in Southeast Sulawesi Province, Indonesia. The efficiency was measured by using ratio of the cost purchased (input) and the number of services (output) in community health centres (puskesmas). Democratic variables was measured using an index that consist of components of democracy such as public participation, responsiveness, transparency and equality. Spearman’s correlation model is used to examine the association of variables. Indepth interviewwas conducted to exploreaspects behind the association of the two objectives of administration.