Purpose: School principals are presumed to be pillars of school health promotion implementation. Their understanding of their role could enhance school health promotion. This study aims to investigate how principals understood their role in school health promotion. Design/methodology/approach: In this study, semi-structured interviews were conducted with six school principals who participated and completed the first cycle of the Continuous Professional Teacher Development programme that was offered by the South African Council of Educators. Snowball sampling was used to sample participants. Findings: The findings of this study showed that principals did not differentiate between concepts of health-promoting schools and school health promotion, the meaning was the same for them. They focused on any health improvement within the schools, regardless of its conceptual nature. The second finding pertains to the role of the principal as a manager, while the third was on expedition of collaborations and partnerships. Research limitations/implications: This research was limited to school principals who completed the Continuous Professional Teacher Development programme. It, therefore, does not include perceptions of other principals. Originality/value: The study findings suggest that despite inability of schools in poor communities to implement effective school health programmes, the principals of the sampled schools were aware of their roles. This is positive, as the efforts to enhance health promotion initiatives would focus on developing and empowering principals to improve their performance.