ASTHA focuses on ensuring the delivery of quality, affordable healthcare services in rural communities through the capacity development of Community Paramedics and Community Paramedic Training Institutions. The project engaged Consiglieri to assess the attributable changes brought about by ASTHA in the lives of community members and Community Paramedics. The assessment employed a mixed-methods approach, guided by the OECD DAC evaluation criteria, and captured quantitative data from 127 Community Paramedics and 519 patients across 12 project locations and 5 non-project locations. Qualitative data were collected through in-depth interviews and consultations with Community Paramedics, Community Paramedic Training Institutions, Community Paramedic Associations, and local government healthcare providers. Analysis of data from the project locations provided concrete insights into the project’s progress in achieving its key performance indicators. In addition, the comparative analysis between project and non-project locations generated valuable insights into ASTHA’s contribution to systemic change, its effectiveness in improving service delivery and access to care, and the sustainability of the outcomes achieved, while also identifying key lessons to inform future programming and scale-up efforts.