Between 2006 and 2010 UNRWA went through an Organizational Development process that allowed the agency to shift the responsibilities of individual departments giving them the ability to undertake reforms. Continuing this process the UNRWA health department started developing a comprehensive reform effort in 2009. The impetus behind this reform was the changing needs of the Palestine refugee population. Demographic pressures put an additional burden on the whole system and behavioral practices imposed a larger NCD burden on the health system. Along with these needs the health department took into account their resource constraints and identified the FHT approach as a key element of the reform of the health system. The evaluation covers the FHT approach that is currently being implemented by the UNRWA health department. The evaluation was conducted in October and November of 2013 using a mixed team approach with external experts supported by UNRWA evaluation division staff.