The poor performance of the Indian Public Health System is widely acknowledged. Analysts have attributed this failure to a number of factors, which include almost all the components that make a system functional, that is, infrastructure, human resources, logistics, and participation of the community. However, some attribute this failure primarily to low and declining public investment in healthcare and secondarily to structural and managerial weaknesses in the system. After groping with the challenges for decades, the planners have come up with a comprehensive mission-oriented approach to revamp the rural healthcare delivery system, which was aptly named National Rural Health Mission (NRHM) [Box 1]. The mission was launched on 12 April, 2005, to be completed in a time frame of seven years.(1) By the end of 2008, the mission has lived half of its life. It is the right time to take stock of the gains and achievements and critically analyze the failures and lapses. Box 1 National Rural Health Mission Large variations exist in the health system and its performance, which is clearly evident in the fact that some states have been performing better than others in the pre-NRHM period. A need was felt by the Mission to bring the states that had been lagging behind at par. In order to provide an impetus to the primary healthcare infrastructure, so that the delivery of family welfare services could be made more efficient, the Empowered Action Group (EAG) was constituted by order of the Government of India on 20 March, 2001, as an administrative mechanism, for the purpose of closely monitoring the implementation of the family welfare program.(2) Initially it included eight states. In spite of a single window clearance mechanism for approving schemes to finalize strategies and address gaps in the ongoing programs, the states failed to show a desirable improvement in health indicators. Thus the mission focused on 18 poorly performing states, which included eight North Eastern states, eight Empowered Action Group (EAG) states, and the hilly states of Himachal Pradesh and Jammu and Kashmir.(3) The NRHM framework represents a conscious decision to strengthen public health systems and the role of the state as a healthcare provider [Figure 1]. It also recognizes the need to make optimal use of the non-governmental sector to strengthen public health systems and has increased access to medical care for the poor. In order to meet the core objectives of NRHM [Table 1], increasing the public expenditure on healthcare from 0.9% of GDP to 2 – 3% of GDP in an effective manner, through an increase in the central government budgetary outlay on health and ensuring a matching increase of the states' expenditure on health by at least 10% annually is one of the major steps.(3) As a corollary, the state health sector is required to develop capacities to absorb this additional fund flow. Table 1 Statistical targets of NRHM Figure 1 Organizational structure of the National Rural Health Mission The core objective of NRHM is to create fully functional health facilities within the public health system. It is expected to provide a certain service guarantee at each level of the healthcare delivery system starting from a Subcenter (SC) to a District Hospital (DH).(3) The structural correction of the health system under NRHM is based on the following five principles. (1) Setting norms and standards and achieving service guarantees, (2) Innovations in the human resource development for the health sector, (3) Increasing participation and ownership by the community, (4) Improving the management capacity and (5) Flexible financing. In a large country with inter-regional and intra-regional variations and inequalities, it is a challenging task to review the overall scenario of the mission's status in the country. However, the performance of NRHM can be reviewed under the following ten components.