The Government of the Democratic People’s Republic of Korea was one of the first countries to successfully apply for Gavi, the Vaccine Alliance (Gavi)’s new funding window on health systems strengthening (HSS) in 2006, and was subsequently awarded a second Gavi HSS grant in 2014 (HSS 1 and 2, respectively). This report summarizes the findings of an “end-of-grant” evaluation of the first Gavi HSS grant and the midterm progress assessment of the second Gavi HSS grant, covering the period from 2007 to 2017. The objectives of this evaluation were to: assess the extent to which Gavi HSS support provided to the Democratic People’s Republic of Korea during this period achieved, or is on track to achieve, its objectives; determine to what extent it has contributed to strengthening the health system of the country; identify issues encountered during implementation that have affected the overall results; and share the lessons learnt for informed decision-making with regard to future support from Gavi and other international donors to the Democratic People’s Republic of Korea. The methods employed for this study included a document review, an analysis of secondary data, a selfassessment, key informant interviews and direct observation of health facilities during an in-country mission. The findings suggest that Gavi HSS support can be regarded as a success. The support has contributed to strengthening of the cold-chain system, human resource development and the process of planning for immunization service delivery. Gavi HSS support has helped in maintaining high and equitable immunization coverage and introduction of new vaccines in the country. In addition to meeting targets set in the proposal, Gavi HSS support in the Democratic People’s Republic of Korea has also achieved many important outcomes that were not explicitly stated in the proposal, such as using the cold chain and logistical infrastructure for delivering other health services by health facilities, and the enhanced synergistic collaboration between the United Nations Children’s Fund (UNICEF) and World Health Organization (WHO), which are the two implementing agencies. Through this support, Gavi has proven to the global community that the alliance was able to make an impact in a country with multiple geopolitical challenges.