Abstract: Kenya has advanced significantly because of the M&E system that has been in place for some years. To determine whether an intervention or program is successful in achieving its goals, monitoring and evaluation entails gathering and analyzing relevant data over time. The gaps in service delivery were identified, their causes were investigated, and specific measures to close the gaps were developed using an empirical gap method. Thus, the study focused on answering the question; What is the influence of monitoring and evaluation of organizational structure on health service in the County government of Nyandarua? The study used a descriptive survey methodology.