Background: In the past three decades, health reform has become commonplace in most countries. Such that reforms decentralized governance of health systems has been adopted in some countries as a subset of broader health reforms or as a preferred management strategy. This review was performed to synthesize evidence around this issue. Specifically, the objective was to answer the question: “What is the role of devolution in service delivery, health workforce and medical commodities acquisition?”. Methods: CrossRef, Google Scholar, Academic keys, Open Academic journals index, MEDLINE, Embase, CINAHL, and PsycINFO were searched with terms related to devolution and health. The search included terms related to service delivery, health workforce and medical commodities. Findings were presented within a narrative synthesis. Quality of the evidence was evaluated using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Findings: A few studies, all cross-sectional studies, met the selection criteria for this review. Most studies noted the major benefits resulting from devolution in terms of local governance and citizen participation in the health service delivery sector. The UK and India are some of the countries with evidence of how devolution impacts positively from accountability and participation. Some of benefits reaped include developed leadership, effective monitoring, promotion of quick delegation of work and generation of interest among employees. In Kenya, health sector still undergoes significant human resource deficiency, in spite of the government investing over the years from independent and also considering the devolution of health services. Healthcare workers shortage affects how health institutions functions. Studies showed that health workers positively respond to the demands of human resource of a decentralized unit if they look for employment in it, if a post is offered, they accept, and stays in service. Their ability and willingness to act in response to local demands are due to a number of factors. However, there is little literature on the best level of the government in provision of public type medical services. The recent focus has been entirely on the merits of local provision. Local governments are more responsive to their citizens compared to the central government. Conclusions: A universal objective of health systems should be to reduce inequality in health and promote equity, but the impact of Devolution of health system governance on equity has been questioned.