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Background Falls among older people are a major cause of the global burden of disease. This study investigated the implementation of the Falls and Fracture Prevention Programme, a multicomponent population-based intervention, across diverse districts in New Zealand.Methods We conducted a comparative case study through 28 semi-structured interviews with programme coordinators and managers across four districts. Transcripts were analysed using the programme framework, focusing on the implementation and outcomes of three primary components: Community Strength and Balance, In-Home Strength and Balance and Fracture Liaison Service.Results We found both similarities and differences in the implementation of the programme’s components. All districts successfully engaged community providers to deliver accredited group exercises for Community Strength and Balance, though there were variations in human resources and community awareness of sessions. In-Home Strength and Balance implementation differed, affecting attendance, with successful implementation linked to empowering private physiotherapy organisations; however, funding withdrawal raised sustainability concerns. Variations in the Fracture Liaison Service implementation underscored inconsistencies in patient identification, highlighting the importance of primary care engagement and standardised protocols. Primary care involvement across all components was essential for successful implementation, and districts with higher primary care engagement and well-planned awareness sessions reported increased patient attendance.Conclusions Overall, effective screening, primary care engagement and collaboration with private organisations and community providers were vital for the successful implementation of this population-based falls prevention programme.