The Institute was commissioned by the Department of Planning, Government of Andhra Pradesh^[1] to carry assess inherent and operational gaps in the rural health care system of the State. The assessment was carried out in 6 districts of the State. Critical gaps in infrastructure; human resources; infrastructure; accessibility infrastructure such as neighborhood and internal sign posting, functioning telephone at PHC, and proper dissemination of telephone numbers among the community; water supply, hand wash and toilet facilities; and patient transport were identified. There existed a clear gap in PHC role performance. PHCs are concerning themselves with medical care delivery and program implementation. Public health surveillance and regulatory interventions such as sanitary surveys and water quality monitoring, are mostly lacking.  The study revealed that during the past ten years, 55.56% of the PHCs did not have even a single doctor for periods ranging from 0.1 to 7.4 months per annum. Further, 50% of single MO PHCs were without a doctor for more than one month per annum. The study provided evidence regarding impact of residential distance and private practice on operational availability of doctors. A key finding was that addition of a second MO post to existing single MO posts would be a cost effective intervention to improve availability of doctors in the PHC. A framework for assessing community engagement with, and by health care institutions was also developed by the study.