The objective of this research was to examine the role of local governments in promoting equity in PHC. The study sample comprised 10 randomly selected rural local governments from Tigrai and 10 from North Omo. Qualitative and quantitative data collection methods were used. A questionnaire was administered to 60 local governors, 11 focus group discussions were held with key groups; and in depth interviews with 14 key informants. Document review of local government (LG) archives, enrolment records from 276 primary schools and routine data from 58 health units was collected for quantitative data analysis. Data were analyzed and simple statistical tests, correlation and multiple regression analysis for the quantitative data. There were significant differences in female enrolment, mean antenatal visits and local government performance scores between the two regions. A key explanatory factor was that LG composition greatly influenced LG performance: The presence of women and farmers in the Local Government Assembly (LGA) and the level of education of local governors influenced local government performance.