The National Rural Health Mission was launched in Himachal Pradesh in April 2005 to provide accessible, affordable and reliable healthcare to the rural population, especially the vulnerable sections of the society. The programme envisaged convergence of various existing stand alone healthcare programs, decentralisation of the planning process, with special emphasis on bottom up approach in decision making and creating better linkages and cooperation amongst various social sector departments. A mid term review of the implementation of the program in the fourth year of mission period (2005-2012), highlights the areas of concern and issues which needs to be addressed for successful achievement of the objectives set out for the Mission. The review underlines glaring gaps in planning, implementation and monitoring activities. Absence of household survey, and prospective plan and lack of inputs from the community at the grass roots level in the annual plans rendered the planning process an exercise in futility. While the number of health centres exceeded the norm, these could not ensure reliable and accessible healthcare to the targeted beneficiaries due to inadequate infrastructure and insufficient manpower. Some of the key initiatives of the NRHM like ASHA and village health and sanitation committees have not received the required attention. Public spending on health sector also remained constant during the last four years.