 This research examined the implementation of a new policy aimed at ensuring equity and culture-sensitive health services for indigenous populations in the Philippines. It found that middle managers play a critical role in translating central directives to operational action, and that indigenous program managers are more likely to support such policies if they have personal or organizational commitments. However, these individuals may be overruled by other factors, such as lack of leadership and weak institutional capacity. This article was authored by Ryan Seaginaran, Erlinda Biolupias, and Lucy Gilson.