Little concrete evidence exists to date,however,to confirm that these potential benefits can be realized. Few developing countries have long-term experience with health dector decentralization, and its impact on the management of the sector and on the services it delivers has rarely been evaluated. Thus, the debate whether decentralization does indeed improve equity, efficiency, accountability and quality in the health sector continues without date to inform it. Although anecdotal and country-study evidence confirms that poorly designed and hastily implemented decentralization has serious consequences for health service delivery, we do not have a clear analytical framework to isolate or generalize the factors behind successful and unsuccessful decentralization.