This is a report of an evaluation of the Arrangement from inception to August 2009. All activities associated with the implementation of the Arrangement were evaluated, including recommendations 4 - 21 and 28 - 38 of the Health Report prepared by the New Zealand Ministry of Health (MOH) with CMDHB in 2004. The design and construction of the new hospital were excluded. The evaluation gave an opportunity for Government of Niue (GON), CMDHB and NZAID to assess their partnership and relationships and to assess how Programme activities have supported the original objectives set. Findings will be used to inform decisions on future support to the Niue health sector.