This paper examines decentralization experiences in Indonesia, the Philippines and Vietnam during the last 18 years (1985-2003). The analysis suggests that decentralization dividends so far have been modest and concentrated in some areas in the country. This is partly due to the limited potential gains that can be realized under the less than favorable macroeconomic and political context in which decentralization was introduced. More importantly, however, current arrangements within the health sector have not worked well as hoped, including ensuring access for the poor to quality health services. To improve the gains, a stewardship role for the MOH is suggested. In this role, the MOH would focus on critical health functions, namely: communicable disease surveillance and control; standard setting and quality assurance for devolved health services; and pharmaceuticals; ensuring access of the poor to health services; and, sustaining health financing.