This case looks at the challenges of managing and evaluating new models of healthcare delivery in international development. It follows the story of a social franchising initiative funded by the Gates Foundation in Bihar, one of India's poorest states. The initiative sought to create primary healthcare centers at scale in remote rural parts of the state through a franchisee based private sector intervention. These centers were intended to provide high quality preventive care targeted at certain infectious diseases through technology and telemedicine enabled infrastructure. It was expected that patients, some of the poorest in the world, would be willing to pay consulting fees in recognition of the higher quality compared to local alternatives. World Health Partners, an Indian NGO with experience in healthcare, received a grant of $23 million dollars from the Gates Foundation to execute this program. The Foundation also awarded a grant of $3 million to a group of academics to conduct a Randomized Control Trial to evaluate the effectiveness of the intervention. The case details the difficulties faced by WHP in implementing this ambitious program as well as the clash of incentives with the evaluators. There is also a discussion of how the the Gates Foundation managed this grant and the challenges posed by its organizational structure. The case seeks to put readers in the shoes of an executive at the Gates Foundation who must make an important decision regarding the future of the program after the evaluation, with its limitations, finds no evidence for the effectiveness of the intervention.