The 1978 Alma Ata Conference presented the manifesto to attain global health for the next century by providing basic health care aimed at the urban and rural poor of the developing world. While the goals of Alma Ata were noble, they were untenable. Today, developing countries face serious issues of equity in health care delivery and fairness in health care management with even a greater need to transform the management systems and practice. Primary health care remains a cornerstone of building the capacity of health systems. Devolution in health sector in Pakistan seems like a chance to re-exert Alma Ata agenda. To achieve the millennium development goals by 2015, revitalization and effective implementation of primary health care will be a vital reform