Many developing countries have or are in the process of implementing decentralization of financial management systems. The reform can take various forms: self-financing or cost recovery through user charges and co-financing or expansion of local revenue through taxation. This study examines the impact of decentralization of fiscal/financial management of cost sharing revenue on hospital efficiency. Potential, decentralization of financial management of cost sharing is expected to improve coverage and accessibility of health services, quality of services and efficiency in the delivery of health care. The main aim of this study was to review the impact of fiscal decentralization of the cost sharing reform on the efficiency of Kenya’s health care delivery and to identify factors that need to be addressed in order to enhance the success of the reform policy. The study utilized secondary and primary data from 39 public health facilities comprising of 27district hospital and 12 sub-district hospitals .The sample size for the primary data collection was 178 patients and 57 health workers from 4 purposively selected facilities.