The purpose of this evaluation was to assess the extent and quality of implementing the Reaching Every District (RED) approach in North Sudan and its impact on immunization coverage. The evaluation was conducted in all 70 districts of North Sudan, excluding Darfur. District RED implementation data for 2006 were collected from district staff and used to quantify implementation by calculating Implementation Scores (IS) using a 10-point scale, with 10 being fully implemented. Overall RED IS ranged from 1.6 to 8.9. The percentage of districts with diphtheria–pertussis–tetanus (DPT) 3 coverage ≥80% increased as the overall RED IS increased, 78%, 87%, and 96% in low-, medium-, and high-scoring groups respectively. The degree of RED implementation varied across districts. Although it is not possible to directly attribute the overall increase in DPT3 coverage to RED implementation, RED implementation quality might be associated with improved DPT3 coverage.