The example of Shishelweni demonstrates that in the context of high prevalence of HIV/TB infections and limited resources available decentralisation of HIV and TB care from regional and district hospitals to primary health care clinics and community level is the way to improve access, coverage, effectiveness and efficiency of service delivery. It also improves satisfaction and acceptance of health service providers, direct beneficiaries and the wider community. In conclusion, decentralised health care with task shifting in Shiselweni has strengthened human resources for health, empowered PLWHA and the wider community. It resulted in improved access and better direct treatment outcomes. Through lowered burden of the opportunistic infections it might have contributed to the overall reduction of mortality in the region. Decentralization is an efficient way of using scarce resources; therefore it requires strong commitment from all stakeholders, in terms of adequate policies, practices and effective funding mechanisms.