Guinea-Bissau meets many, if not all, criteria that characterize health systems in fragile states. The country’s health system faces persistent challenges related to low public spending, poor infrastructure, inadequate supply of health workers, inadequate clinical and managerial training systems, malfunctioning referral system, non-operational health-information systems, weak governance and inadequate management capacity and systems (such as budgeting, public financial management and human resources management). Public spending accounts for about 20 percent of total health spending and is mostly used to pay staff salaries, while donors finance nearly 90 percent of the recurrent costs of the sector, including medicines and other critical health inputs. This report provides a comprehensive diagnostic of the health service delivery system in Guinea-Bissau. It explores quality of care, workload/productivity and absenteeism. A service delivery indicators (SDI) survey was implemented to cover these and other key aspects of the health system for which no data were available in Guinea-Bissau (such as public expenditure tracking survey). The report provides an extensive analysis of the data and links it to other analytical and operational work under implementation in the country.