Dissertation (Master in Public Administration)This study assessed the impact of decentralization reforms on health service delivery in the local government authorities in Tanzania. The study specifically assessed the community perceptions on the role of decentralization reforms, the influence of decentralization reforms on improved quality, access and delivery of health care services and finally identified and analyzed major challenges in the implementation of decentralization reforms in Tanzania. Karagwe District was the case of this study. Data for this study was obtained from a representative sample of 100 head of households using structured and semi-structured surveys and interviews. Analysis of data in the study was mainly qualitative wherein some qualitative techniques were used. The use of statistical values such as frequencies and percentage were meant to justify qualitative arguments. Key findings from the study suggest that community members in the study area perceive that decentralization enhances and promotes public participation, accountability, good governance and democratic process and mobilization of resources among others for the effective health care services delivery. On the other hand, the study suggests to some extent, decentralization reforms have improved quality, access and delivery of health care services in the District. Nevertheless, a number of challenges prevail and consequently, they constrain effective delivery of the services. These include limited financial and human resources, the limited autonomy of the Local Government Authorities, political interference and the stakeholder’s involvement among others. In the end, the study recommends among others that the Central Government should provide financial powers to LGAs, capacity building to LGAs should be prioritized on resource mobilization. Also, the Central Government should ensure adequate and equitable services through the developed proper health care plan, management of human resource in LGAs should be left in the hands of LGAs, citizens should be effectively involved and made aware of what entails in decentralization reforms.