Abstract Objective To provide insight of national activities and international assistance in PHC reform and to assess their effects on technical and allocative efficiency as well as financial sustainability of primary health care in the Republic of Serbia. Materials and methods Analytical framework of the study consisted of gathering and reviewing of relevant political documents, international assistance project documentation, and analysis of routinely collected national statistical data based on the evaluation model of three groups of criteria: allocative, technical efficiency and financial sustainability in the public sector of Serbia from 2000 to 2007. Time trends were analyzed by Poisson regression models using average annual percentage changes – AAPC, and the percent of targeted change achieved by progress quotient – PQ. Results Allocative efficiency of the PHC during period of 8 years was improved, but technical efficiency was almost unchanged for all service, except for preschool health care. Financial sustainability was also improved measured by indirect indicators of health expenditure. Conclusions Results of this study indicated that we are on the right track with PHC reform, and international support is in accordance with the reform goals. Our approach has been and will remain incremental, gradualist and multi-faceted.