The implementation of NHI is a very large and long term initiative (at least 14 years) in which many players are involved. Whilst there is little doubt that SARRAH has played an important role in the initial stages, and will continue to do so, it is not possible to demonstrate causal links between these inputs and the intended final impact, i.e. improved quality of health services, which is very broad. It is, however, possible to assess SARRAH activities and demonstrate their contribution through intermediate outcomes. By 2014 we propose to evaluate impact in terms of trends in health and service delivery indicators in those aspects where SARRAH has played a more direct role.