The recent preparation of the Operation and Maintenance (O&M) Manual for Palestinian municipalities is an important step to guide them towards preparing and implementing their O&M priority-based plans, considering scare resources. During the course of preparation of the Manual, the proposed procedures were applied at ten pilot municipalities. This study aims to explore the outcome of the implementation of the 2014 O&M road maintenance plans at these municipalities. To achieve this, analysis of the outcome of a questionnaire designed to collect relevant information from these municipalities was conducted. The results show that seven of the targeted municipalities used the prioritization criteria proposed in the O&M Manual. Despite that the remaining municipalities had the liberty to slightly change the relative weight of the indicators, sensitivity analysis was conducted and indicated robustness of the indicators. The average percentage of roads lengths of the actually maintained to the planned was 35%, suggesting that the plans were ambitious and need to be more rational. Most of the allocated funds for road maintenance came from the municipalities own budgets, indicating need to have more financing by the government to ensure the integrity of the municipal road infrastructure assets. The results also indicated that 95% of the maintenance works were executed through external contracts, and that the municipalities need to be supported and equipped to conduct the basic road maintenance works.