This study explored the status and effect of the service delivery management (SDM) by the District Development Authorities (DDAs) towards the growth of small and medium entrepreneurship in the Eastern Highlands Province (EHP). It focused on the SDM elements of service culture, service quality, employee engagement and customer experience approaches. Utilizing the mixed method to research, the data were gathered through survey and interview from the owners-managers of 160 SMEs operating at the 8 districts of Eastern Highlands Province. The data were statistically processed using frequency distribution, weighted mean, rank, standard deviation and Chi-square test. The study found out that the SDM approaches for service culture, service quality, employees’ engagement and customer experience are less operative, with observed weaknesses and shortcomings that require improvements; and therefore meet only some expectations of the beneficiaries. There is no relationship between organizational culture and leadership to the progress of small and medium entrepreneurship. The causal strategic management measures along the study’s independent variables indicate that SMEs in EHP are aware of their role as partners in socio-economic development; desirous to work with the DDAs in their respective districts towards growth of small and medium entrepreneurship in the province. The study suggests other areas for further research.