This study sought to investigate the Fiscal Decentralization and Primary Health Care Services Delivery in Mbale District. It was guided by three (3) objectives that included the following; (i) to establish the state of fiscal decentralizationon Primary Health Care Services Delivery; (ii) To identify the extent of Primary Health Care Services Delivery; (iii) To establish whether there is a significance relationship between fiscal decentralization and Primary Health Care Services Delivery in Mbale district. It was guided by three sampling techniques: stratified sampling, purposive sampling and simple random sampling. A descriptive correlation design was adopted. A researcher made a self-administered questionnaire was administered and interview guides from respondents. Purposive and random sampling procedures were employed.  Percentages and frequencies were used to analyze categorical data. Pearson Product moment Correlation was used to find levels and significant relationships, Regression analysis was used to find the effect of fiscal decentralisation on Primary Health Care Services Delivery.  The findings indicates that (39.2%) of the respondents were between the ages of 21-29 years. For gender it was revealed that (70.0%) were males and (30.0%) were females. the findings show that majority of the respondents (47.5%) were married, majority of the respondents (36.7%) have Bachelors Degree. working experience (27.5%) have worked with the organization for more than 5years. Thus, the result shows that majority of the respondents have worked with the organization for more than 5years.the findings on Fiscal Decentralization as an independent variable revealed that Allocating Revenue source (mean=2.77, std=.73681), expenditures responsibility (mean=2.74, std=.79673), Revenue administration (mean=2.79, std=.95282 ), Intergovernmental transfer (mean=2.77, std= .89644) with the overall mean of 2.76. the findings on Primary Health Care Services Delivery revealed that  Accountability for service delivery (mean=  2.60, std=.53521) Public Education (mean=2.84, std=.51745) Proper Nutrition (mean=2.74 std=.79095) Clean Water & Sanitation (mean=2.69, std=.75473) Maternal & Child Health Care (mean= 2.74 std= .79095) Immunization and Local Disease Control (mean=2.69, std=.75473) Accessible Treatment and Drug Provision (mean= 2.73 std=.78126 ) (mean=  2.72 std=.46278 ) Results show that Primary Health Care Services Delivery was significantly correlated with Fiscal Decentralisation (r=0.773, at Sig=.000). The results further indicated that the relationship that exists between Fiscal Decentralization and Primary Health Care Services Delivery is positive and significantly correlated, (sig.>0.05). This means that Fiscal Decentralization persuade Primary Health Care Services Delivery and the failure to decide clear Fiscal Decentralization well, the less the Primary Health Care Services Delivery. The Public Choice Theory of James Buchanan and Gordon Tullock (1969), on which this study was based were proved right. it is based on an improved allocation of resources in the public sector. And it has four basic elements;

First, regional or local governments are in a position to adapt outputs of public services to the preferences and particular circumstances of their constituencies, as compared to a central solution which presumes that one size fits all. Second, in a setting of mobile households, individuals can seek out jurisdictions that provide outputs well suited to their tastes, thereby increasing the potential gains from the decentralized provision of public services (Tiebout 1956).

Third, in contrast to the monopolist position of the central government, decentralized levels of government face competition from their neighbors; such competition constrains budgetary growth and provides pressures for the efficient provision of public services. And fourth, decentralization may encourage experimentation and innovation as individual jurisdictions are free to adopt new approaches to public policy; in this way, decentralization can provide a valuable “laboratory” for fiscal experiments. it was recommended that, In order to generate more local resources sub-national governments should discover more potential sources of revenue for the district administration, and in line with that the central government should devolve more tax levying powers to lower tier governments in order to increase their own sources of revenues, which later will relieve the central government in form of grants transfers, and also restructuring of resource allocation and establishment of resource sharing mechanisms should be re-introduced.