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This article focuses on the activities of local governments in western Poland with respect to preventive health care in the years 1919-1939 (a key period during which the organizational basis of Poland’s modern public health care system developed). The author notes the regulations and statutory responsibilities regarding public health of the community, district and voivodeship in the years 1919-1939, and she presents the challenges related to the organization of and functioning of local government health care systems in three annexed areas of former Prussian territory (the voivodeships of Poznań and Polish Pomerania). Delivery of health care depended on the organizational solutions then in force and on the existing hospital base and financial capabilities of local government.