In recent years, many countries, both developed and developing, have engaged in a process of decentralization of health service delivery and/or other functions of the health system. In most cases, decentralization has been adopted to improve accountability to local population, efficiency in service provision, equity in access and resource distribution, or to increase resource mobilization. Ghana has a long history of local government, going back to pre-independence times of the nineteenth century. By 1859 Municipal Councils were established in the major coastal towns of the then Gold Coast. Native Authorities, Councils and Courts were also established to administer law and order under the indirect authority of the colonial government; the limitations of this system was repeatedly put forward in the 1930s and 1940s, and reforms were introduced in 1951 by the Local Government Ordinance (Ahwoi 2010). The government has embarked in a decentralization policy since independence, which was strengthened and amplified by the local government act of 1993 and other legislations. At the present the Government of Ghana (GOG) is committed to strengthen the implementation of decentralization and for that purpose revise and strengthen the policy and regulatory framework governing decentralization. In spite of this long history and successive waves of decentralization reforms, effective decentralization in the country still faces considerable challenges, especially in large social sectors involving large structures. The public health sector is one that has not fully embraced the decentralization model adopted by the GOG, decentralization by devolution to the districts, for a number of reasons that will be discussed in this report. Some functions and responsibilities have been decentralized, but others remain centralized or simply deconcentrated.