Providing efficient decentralised local public services such as healthcare inhard to reach and remote areas has been the recent concern of public finance experts.Thus public finance theory, the public choice, has been devoted to explain the linkbetween decentralised local public service delivery and efficiency. The theory arguesthat efficient delivery of decentralised local public service is achieved through theproximity advantage of local management boards, which enables them (that is thelocal management boards) to provide services tailored to the needs of their respectivelocal communities. Using the public choice’s decentralised local service provision, thisstudy adopted a qualitative design, and accidentally selected and interviewed 40health service users (HUs) and 10 Health professions (HP) in the rural areas of Lesotho.The results show improvement and efficiency in healthcare service accessibility, utili-sation and affordability in the study communities. Again, it emerged that decentralisedhealthcare delivery helped healthcare service providers to gain an in-depth knowledgeof the healthcare needs of the local people, thereby enabling them to adjust services tothe healthcare needs of the community through innovative healthcare delivery stra-tegies, like mobile healthcare delivery service and the mobilisation of trained assistantnurses deployed to serve in remote and hard-to-reach communities. Results furthe

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