The present work has been carried out to develop a performance evaluation framework of distribution network design in public health with specific reference to essential medicines based on six different types of public health distribution networks (PHDNs) prevalent across six Indian states. We evaluated the performance of PHDNs on the criteria of cost and service and also on the sub-criteria of cost and service by following the analytic hierarchy process. We utilized the pairwise comparison method in determining the relative importance of criteria and sub-criteria by seeking responses from several experts and subsequently evaluated the PHDNs on all sub-criteria in a 7-point Likert scale by seeking views from the same experts. Finally, we developed the cost-service matrix, in which cost and service have been depicted in the horizontal and vertical axes, respectively. We demonstrated the performance of six PHDNs in this matrix in terms of cost and service by plotting scores obtained by them on cost and service, respectively. The findings of the study provide rich insights to the policy planners of public health.