The National Rural Health Mission was launched by the Government of India in April 2005 for strengthening rural health care institutions by providing adequate infrastructure facilities and funds. The Mission sought to provide universal access to equitable, affordable and quality health care facilities in rural areas. This performance review of the implementation of the National Rural Health Mission in Bihar revealed improvement in flow of funds to rural health institutions and better health awareness among rural population. However, the objectives of the Mission were not achieved due to inadequate surveys, non-preparation of Perspective Plan, ineffective financial management, inappropriate community participation, lack of basic infrastructure facilities, inadequate equipment and human resources. Accredited Social Health Activists selected were not imparted training in four out of five prescribed modules. Delivery of services under different disease control programmes also suffered due to improper planning, poor quality of services, non-achievement of targets etc. Functioning of Rogi Kalyan Samities was not effective and Village Health and Sanitation Committees were not formed.