The study was carried out in Makindye Division, Kampala District and it was carried out on the impact of decentralization on health service delivery in Makindye Division. The objectives of this research were to examine the impact of decentralization on public health service delivery; to examine the challenges faced in delivering public health services and to come up with possible measures to the problems encountered in health service delivery. The study used a descriptive research design to describe issues relating to decentralization and public health service delivery. The population included the local government officials, local leaders and the local people in the area. Simple random sampling and purposive sampling procedures were used in the study to obtain a sample of 90 respondents. Data was collected from both primary and secondary sources using key informant interviews and interview guides. Data was analyzed qualitatively in themes that reflect the study objectives. The study found out that decentralization has led to the establishment of mutual public health goals through community collaboration, establishment of new health centres and improvement of primary health care. This impact has made a great improvement in health service delivery to the public. However, findings established various challenges faced by local governments in ensuring delivery of public health services and these included lack of transparency in allocation of resources, lack of enough health equipment, facilities and personnel, lack of funding at the local level and the influence of some politicians with selfish and political ambitions that hinder effective service delivery. Among the solutions, it was suggested that there should be motivation of health workers to enable them serve the public effectively, implethent and improve public-private partnerships in health service system and implementation of strict laws to those who misuse funds meant for improving the health standards of the community. Therefore the study recommended that the government and other stakeholders should step up their efforts to educate the local communities on their rights and obligations in taking part in the growth and development of health service delivery.