TMG implemented an end-of-project evaluation to assess the achievements, challenges and sustainability of the program to inform follow-on programming. The evaluation also responded to USAID’s questions that focused on: program management effectiveness; the approach, effectiveness and quality of assistance; M&E indicators, and the use of M&E for planning and management; quality assurance standards and criteria used for renovations; and strategies, priorities, and lessons learned in capacity building and sustainability for future guidance in implementation. The evaluation methodology was observational and qualitative with some quantification. It took into consideration both the engineering and health-care aspects of the renovations and incorporated elements of a performance audit. This hybrid methodology was required to fulfill the objectives and answer the broad range of USAID’s illustrative questions. The evaluation included 13 site visits in four of the project’s five geographic regions, key informant interviews, small group discussions and comprehensive document review.