Learning materials developed by the Open University for operational managers in the British Health Service are increasingly being used in other countries, often with adaptation and translation. This paper reports an evaluation of the use of these learning materials in Australia, the Cayman Islands, Hong Kong and the UK. Participants'views of the workbooks that constitute the core of the programme, the assessment process and the tutorial arrangements were mostly positive. However, the materials were not always seen to be successful in addressing individuals in their specific health care contexts. Some participants also reported difficulty in managing the workload within the anticipated study time. Participants were also asked to assess the extent to which they had developed management competences as a result of their studies. In almost all cases, learners reported progress, but there was considerable variation between cohorts in different countries. Possible explanations for these differences are explored. [Copyright of Innovations in Education & Teaching International is the property of Routledge. Full article may be available at the publisher's website: http://dx.doi.org/10.1080/14703290110073291]