This 159-page midterm performance evaluation of the Bangladesh Non-governmental Organizations (NGO) Health Service Delivery Project (NHSDP) examines the project’s progress toward meeting its goal and objectives. NHSDP is the United States Agency for International Development (USAID)/Bangladesh’s largest health initiative; this flagship project is the latest in a series of programs going back to at least 1998 that have sought to improve the ability of local NGOs to provide basic health services to the poor. NHSDP was designed in 2012, when USAID was implementing significant procurement reforms and emphasizing the need to work more directly with local organizations. In 2013, USAID received gift funds from the United Kingdom’s Department for International Development (DFID) to co-fund NHSDP, which expanded the scope considerably. The DFID supplementary fund has supported the current NHSDP activities and strengthened its focus on family planning (FP) and maternal health outcomes, with a specific focus on improved service delivery for the urban poor.