Introduction: Primary health care is the nucleus of country's health care delivery system. Bottlenecks in delivery of services at PHC level leads to decreased effi ciency of health system and indirectly affects health of the citizens of a country. Keeping these issues in mind a study was carried out with the objectives i)To identify constraints/bottlenecks in implementation of elements of primary health care ii)To fi nd out solutions to address these bottlenecks. Materials and Methods: This crosssectional study was carried out in Cuttack district during Dec 2010 and January 2011 using a semi-structured pre-tested questionnaire. Data regarding various diffi culties faced while delivering health care services at PHC was collected from participants attending district level IMNCI (Integrated Management of Neonatal and Childhood Illness) training after getting verbal consent. All 72 respondents who had attended the training during the above mentioned period were included in this study (Medical offi cer, AYUSH medical offi cer, Maternal Child Health co-coordinators and Block Programme Offi cers). Data were analyzed manually using content analysis. Results: Diffi culty in vaccine delivery, inadequate infrastructure and lack of suffi cient manpower for smooth functioning of JSY, diffi culty in card updation and diffi culty in retrieval of defaulter of alcoholic TB patients for Directly Observed Treatment Shortcourse (DOTS) are some of the problems identifi ed in general. Conclusion: The study identifi ed the need for strengthening infrastructure and manpower to provide quality care for institutional delivery. It also emphasized the need for construction of more number of sub centre buildings which forms the backbone of rural health care delivery system. Identifi cation of loop holes and bridging the gap by corrective action will make the journey towards Millenium Development Goal (MDG) easier.