The Government of Uganda has decentralised health services since 1993. Despite the positive achievements as a result of this reform process compared to the period during centralisation, the indicators are not impressive. Several challenges still remain. These challenges include: the nature of the health care strategy; access and utilisation of health facilities; funding; ineffective integration of top-down or vertical donor programmes into decentralised systems; weak management; inadequate planning; lack of personnel; un-coordinated distribution of power between different levels of government; poor accountability; and, the health sector reforms overriding the essential differences between private and public sector management. The article, therefore, concludes that these challenges, if not addressed by policy-makers and implementers alike, will easily derail the decentralised health sector reform in the long term. The actors can only