Learning materials developed by the Open University for firstline managers in the British Health Service have been adopted and adapted in a number of other countries. This paper reports a questionnaire-based evaluation of their use in Australia, the Cayman Islands, Hong Kong and the United Kingdom. Participants’ views of the helpfulness of the 18 workbooks that constitute the core of the Managing Health Services programme were very positive across all four countries, as were their views of the assessment process and, in most cases, of the tutorial arrangements. However, there were some significant differences between the views of the cohorts from different countries. Participants were also asked to assess the extent to which they had developed 40 management competences as a result of their studies. Managers from each country reported progress in their competence development, but with considerable variation between countries. Possible explanations for these differences are explored.