There are numerous guidelines that outline best practices for health program monitoring and evaluation (M&E). However health programs are often implemented in less than ideal circumstances where these best practices may not be resourced or feasible. This paper describes how M&E has been conducted for a health service delivery improvement program in remote Papua New Guinea and outlines lessons learned. The lessons were: integrate M&E into every aspect of the program; strengthen existing health information data; link primary data collection with existing program activities; conduct regular monitoring and feedback for early identification of implementation issues; involve the program team in evaluation; and communicate M&E data through multiple mediums to stakeholders. These lessons could be applied to other health programs implemented in low resource settings.