Ratings for the Earthquake Emergency Reconstruction and Health Services Extension Project for El Salvador were as follows: outcomes were moderately satisfactory, the risk to development outcome was moderate, the Bank performance was moderately unsatisfactory, and the Borrower performance was also moderately unsatisfactory. Some lessons learned included: the standard contract for complex time-based assignments was used, under which remuneration is determined on the time the consultants spend carrying out services. This type of contract is widely used for supervising construction and was thus correctly and in good faith used to hire ESEO (Works Supervision Firm - Empresa Supervisora de Estudios y Obras). However, the contract lacked incentives for ESEO to push the construction firms for results, timely compliance with the milestones, and adhering to their schedule, since their payments were not contingent on the firms' progress. Working with joint ventures for civil works can be challenging. This project provided a case of ineffective joint ventures. The firms selected lacked previous experience in hospital construction. The foreign firm did not have a solid presence and network in the country, which meant it could not effectively communicate with the Project Coordination Unit (PCU). The design and implementation experience of restoring physical assets after a disaster shows the importance of assessing the appropriateness of ERL in terms of time and resources, and reassessing the needs and design against the latest sectoral trends. Besides, the component one preparation timeline and available budget were not sufficient to realistically assess the damage and health sector needs.