A multi-agency team reviewed published and unpublished reports related to the implementation of Rwanda's laboratory activities, conducted site visits to observe how the laboratories functioned, and interviewed staff at the Ministry of Health and partner agencies. The National Reference Laboratory (NRL) coordinated the site visits to seven district hospitals and two health centers. These sites were selected as a convenience sample because each health center and district hospital in Rwanda offers the same standardized group of laboratory tests as specified by government policy. Interviews and follow-up discussions were conducted with laboratory personnel in charge of the district hospital and health center laboratories. Interviewees included district supervisors and representatives of disease-specific programs for tuberculosis (TB), malaria, and HIV/AIDS. We also met with personnel at the Ministry of Health's Epidemiology and Health Prevention unit, and with staff responsible for the Health Management Information System. Experiences with external support to laboratory services were gathered through interviews with locally-based partners who worked closely with the Ministry of Health and the NRL including WHO, CDC, Columbia University and the United States Agency for International Development (USAID).