This study attempts to examine the extent of leakage in the Cameroonian health sector and identify its sources. The analyses in the study are based on the Public Expenditure Tracking Survey data collected in Cameroon in 2004. The findings reveal that 18.8% of the actual budget allocations of decentralized health services in the Ministry of Public Health do not reach them. Health centers, which are the frontline healthcare providers, receive only 26.4% of their actual budgets contained in the recurrent expenditures of the decentralized health services. We investigate the institutional factors that correlate with the leakage rates and identified the factors that affect the likelihood of health centers receiving public funds. The study finds weak compact and voice institutional links in the Cameroonian health accountability system. The need to effectively control and monitor public funds, improve the information flow mechanism and improve the wage/allowance scale is highlighted. Finally, spending rules should be strictly respected and extra-budgetary spending restricted.