What are the influences of school-based management (SBM) on schools’ organizational health? This study assessed the effects of SBM on schools operating in a centralized system of education. The health qualities of 28 schools were measured in a longitudinal study spanning 3 sequential years, including the year before introduction of SBM in schools and in the 2 years that followed implementation. The results indicated no significant changes when comparing the integrated index for school health among the 3 years. However, significant differences appeared when the various subsets of school health were compared. The results indicated that teachers put more emphasis on children's outcomes. Yet, at the same time, teachers reported having lower morale and increased bureaucratic load in comparison to the circumstances that existed in their school prior to the introduction of SBM. Implications for student growth and teacher development are discussed.