The study examined the influence of culture alignment on organizational performance. The research was anchored on three theories: Resource-Based View (RBV), Institutional Theory, and Stakeholder Theory. The Resource-Based View theory suggests that organizational performance is influenced by the organization’s internal resources and capabilities. The Institutional Theory proposes that organizational performance is shaped by the institutional environment in which the organization operates. The Stakeholder Theory emphasizes the importance of considering the interests and needs of various stakeholders in achieving organizational performance. The study employed a descriptive and explanatory research design to investigate the relationships between strategy execution, process alignment, culture alignment, and organizational performance. The descriptive design was used to describe the characteristics of the study variables, while the explanatory design was used to explain the relationships between the variables. Data was collected from 221 respondents across various public health facilities in Busia County using structured questionnaires. The questionnaire was designed to measure the constructs of strategy execution, process alignment, culture alignment, and organizational performance. The reliability of the study constructs was assessed using Cronbach’s alpha, which yielded coefficients ranging from 0.7 to 0.9, indicating high reliability. The validity of the study constructs was assessed using content validity, construct validity, and criterion validity. The questionnaire was reviewed by experts in the field to ensure that it measured the intended constructs. The results of the factor analysis confirmed the factorial validity of the constructs. The criterion validity was assessed by correlating the study constructs with organizational performance, which yielded significant correlations. The data was analyzed using both descriptive and inferential statistics. The descriptive statistics were used to describe the characteristics of the study variables, while the inferential statistics were used to test the hypotheses. The correlation analysis revealed significant positive relationships between strategy execution, process alignment, culture alignment, and organizational performance. The regression analysis revealed that culture alignment had significant predictor of organizational performance. The study concludes that strategic alignment practices are essential for achieving optimal organizational performance in public health facilities. The findings suggest that public health facilities should prioritize and implement comprehensive culture development strategies. The County Government of Busia and the Ministry of Health should develop strategic alignment support frameworks to provide guidance, resources, and technical assistance to public health facilities. By implementing these recommendations, public health facilities can improve their strategic alignment practices, leading to enhanced organizational performance and better health outcomes.