Abstract Primary care is often the weakest link in health systems despite its acknowledged central importance in promoting population’s health at economical cost. A key reason for the lacunae is that both scholars and practitioners working on the subject typically underestimate the enormity of the task and the range of complementary measures required to build an effective primary care system. The objective of the paper is to highlight theoretical gaps and practical limitations to strengthening. primary care. The challenges and difficulties are illustrated through a case study of China where primary care continues to struggle despite the government’s strong political, financial and policy support in recent years. In this paper, we review the development of primary health care in China and how it is governed, provided, and financed, highlighting the gaps and misalignments that undermine its performance. We argue that governance deficiencies coupled with flawed financing and payments arrangements are major impediments to improving performance. China’s experience offers valuable lessons for other governments seeking to strengthen primary health care……article