Background: Saudi Arabia has invested heavily in the healthcare system by establishing healthcare infrastructures to improve health of the nation. However, it remains to be seen whether it is efficient and effective in providing healthcare services needed. Primary Health Care (PHC), which forms the basis of Universal Coverage, needs to be assessed in terms of performance, challenges and future opportunities to serve a population scattered throughout the vast landscape of the country. Aims: This review aimed to identify challenges within the Saudi healthcare system focusing on PHC services, and to analyse the interrelated factors in order to suggest remedial reforms to further strengthen and improve the healthcare system. Methods: A narrative review for previous studies and governmental reports was undertaken to extract, analyse, synthesize and report the findings. Results: The review findings revealed a number of key areas for improvement in the PHC system. These areas include the scope, structure, infrastructure, finance, increased demand, increased costs, and workforce capacity. Other critical challenges include inequitable access to the services, concern regarding the quality and safety of services, a growing burden of chronic 1 / 14 WHO EMRO | The public healthcare system and primary care services in Saudi Arabia: a system in transi diseases, information system, management and leadership issues, as well as gaps in the current referral system. Conclusion: The Saudi healthcare system needs a comprehensive reform with a focus on PHC.