Government of India launched National Rural Health Mission (NRHM) for providing accessible, affordable, effective and reliable health care facilities in rural areas. This performance audit of NRHM in West Bengal for the period 2005-2009 revealed that implementation of NRHM was affected by the absence of reliable baseline data, as household and facilities surveys were not conducted. Village Health and Sanitation Committees (VHSCs) had not been formed by Gram Unnayan Samitis. Rogi Kalyan Samitis are yet to adequately fulfill their role in monitoring and supervising the functioning of health care centres. The population-health centre ratio was much higher than that prescribed under NRHM. Health centres often lacked basic infrastructure (good quality building, electricity and water supply, etc.) as well as guaranteed facilities (inpatient services, operation theatre, labour room, pathological tests, X-ray, emergency care, etc.). Shortage of specialist medical and nursing staff at different levels of health centres continued to be a cause for concern. There was also substantial shortfall in engagement and training of Accredited Social Health Activists.