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The middle tier, understood as the sub-national actors responsible for education delivery between the national and school level, has attracted interest as a driver and solution to inequality in sub-national education outcomes. Yet little is known about how middle-tier actors in many low-and middle-income countries influence policy implementation and how they support schools to improve teaching and learning. This research examines the role of three district education offices in supporting teaching and learning in basic education schools in Ghana. Each case explores the district office’s priority activities, its management practices, the influence of politics and levels of relational trust. It draws on over 70 semi-structured interviews and focus groups collected in 2021 and 2022. Participants largely comprised district education officials (management, subject specialists and inspectors), as well as stakeholders in the wider education ecosystem: national and regional education officials, district political actors, headteachers and teachers. Adopting a convergence triangulation mixed method design, the research also analyzes nationally representative survey data on district office management activities. While all three districts operate under the same education hierarchy and face significant resource constraints, the study finds significant variation in how, and to what extent, these district offices support teaching and learning. District director leadership (especially instructional leadership) and strategic, supportive school monitoring play a crucial role in effective support for teaching and learning in schools. Overall, this study highlights the need for increased attention to the middle tier's role in education quality and draws lessons for effective district practices to improve teaching and learning.