Lodhran/Rahim Yar Khan (RYK) model of primary healthcare is a home-grown experiment in Pakistan. The model envisaged transferring the management of primary healthcare facilities to a public sector NGO. The paper finds that through the re-alignment of interest groups, the model was replicated in several other districts of the province. It also examines the evolution of stakeholders' behaviour, interest, position and influence in its implementation over a period of time. The study concludes that sustainability of the model remains doubtful unless public sector health bureaucracy is restructured and made to work effectively. Copyright © 2009 John Wiley & Sons, Ltd.