A HEARD Project Evaluation Team examined USAID Guinea’s five-year Health Service Delivery (HSD) Activity. Conducted from December 2019-April 2020, the evaluation examined the HSD Activity’s success in fostering improvements in quality and availability of essential RMNCH services. The evaluation found significant improvements in quality of care, including increased access to family planning services, improved quality of antenatal and delivery care, and expansion of fistula prevention and care, as well as greater access and use of the essential integrated care package. Gains in health systems and workforce strengthening through training, increased data availability, and the provision of equipment, drugs, and commodities were documented through the evaluation. The program’s quality improvement and community engagement approaches face substantial challenges to sustainability with gaps in local ownership, coordination, and human resources at all levels. Evaluation findings were used by the Mission and Government counterparts to inform the Country Development Cooperation Strategy, and in the design of the follow-on program.