Three key lessons learned from OVC (Orphans and Vulnerable Children) evaluations for future public health evaluations: 1) Evaluations need to be designed and incorporated from the beginning of projects rather than as an afterthought, but it is difficult to attract attention to evaluations early on. 2) There are methodological challenges to conducting rigorous impact evaluations of public health programs including non-random placement of programs, lack of suitable control groups, and inability to control for external factors. 3) Evaluations require strong leadership and buy-in from stakeholders to facilitate data collection and use of findings to improve programs. Early and continued engagement of stakeholders is important.