Uganda introduced the decentralization policy in 1997 under the Local Government Act of 1997 that has since undergone four amendments. The policy inherently decentralized service delivery institutions and their governance in order to improve access to services for the rural poor. Based on an analysis of available literature, the paper documents the state of knowledge regarding rural service provision in Uganda under decentralization and identifies knowledge gaps for further investigation. Its focus is on education, health, and agricultural advisory services, as well as the management of natural resources in Uganda. Although enlightening, a review of the broader decentralization literature is beyond the scope of this work. The analysis revealed that results in terms of attaining the objectives of decentralization are mixed. While as anticipated generally decentralization resulted in greater participation and control over service delivery and governance by local communities, local governments are still grappling with a range of challenges, namely, inadequate local financial resources and over-reliance on conditional central government grants; inability to attract and retain sufficient trained and experienced staff; corruption, nepotism, and elite capture. With regard to the specific services, while universal primary education (UPE) policy under the decentralization framework is credited with a dramatic increase in primary school enrollment, public primary education services are still dogged by concerns over financing, equity, quality, and the need for curriculum reform. Some studies show that there has been no improvement in health services with many health status indicators either stagnating or worsening. In general, decentralization of education and health services has not resulted in greater participation of the ordinary people and accountability of service providers to the community. Regarding agricultural extension and advisory services, except for areas serviced by NGOs, the majority of the country does not readily access extension services, because districts have been unable to prioritize the operational expenses. However, there is some evidence that the devolution of responsibility for natural resource management (NRM) has contributed to greater compliance with some NRM requirements in some areas while in other areas forest conditions have declined following decentralization. Generally, evidence on whether decentralization has improved service delivery in Uganda is still inconclusive, and more research is needed.