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Health care reform is an active process currently taking place in a number of countries across the world. In many developing countries decentralization is a significant component of health care reform. The island of Jamaica like many other Caribbean and Latin American nations has undertaken the process of decentralizing the administration of healthcare as a part of nationwide structural reform. We look here at the overall process of health care reform in Jamaica and in particular the impact that recent decentralization has had on issues of equity and strengthening of the healthcare system. Many experts have hypothesized that decentralization on a whole has the potential to negatively impact the health care system. The data showed little evidence for differences in equity along geographic or economic groups but did identify the very old and the very young as particularly vulnerable populations, in addition the data highlighted the significant utilization of the private sector by the population and based on this suggestions are made for successful public-private partnership