This research investigates the changes in the operations of CHSs (Christian health services) in developing countries, particularly their funding bases, relationships with their respective governments, and the extent to which these have resulted in changes to the socioeconomic characteristics of their users. Three main areas of study are woven together: the history of medical mission, health service management and its response to the pressures of the last half-century, and the role of non-state providers in a comprehensive health care system. Evidence was assembled from interviews with officials of twelve UK based mission organisations, a survey of CHSs in thirteen countries, and case studies of CHS provision in Malawi and India based mainly on extensive interviews with selected stakeholders. The research confirmed that funds received by CHSs from mission organisations have declined and are now more often in the form of project funding. CHSs have, for the most part, continued to provide services for the poor in a variety of ways: first, by providing low cost services; second, by developing hi-tech tertiary services, the profits from which subsidise services for the poor; and third, by working more collaboratively with governments, for which they receive varying degrees of financial and other support.