The underutilization of primary health care services has been a major problem in Pakistan’s health care system. The country has gone through health care reforms for improving the utilization of primary health care at public facilities during the last decade. The most important among these reforms include outsourcing the delivery of primary health care to People’s Primary Health Care Initiative through public-private partnership. Objectives: This study aimed to explore the reasons for underutilization of PHC services at basic health units (BHUs) in the rural area of Pakistan. Theoretical thematic analysis was used in this study. BHUs were selected randomly, whereas purposive sampling technique was used to select the participants from the catchment areas of 10 study sites. Results: The findings of this study revealed several reasons for underutilization of PHC services at BHUs. The inadequate provision of medicines, the unavailability of doctors, inadequate laboratory and diagnostic services, obstetric care, and poor infrastructure of BHUs were the main reasons of underutilization. In addition, the inconvenient location of BHUs, the staff absenteeism, charging fee for public services, private practice of doctors, non-responsiveness of staff and poor perceptions about the quality of care also hindered community’s use of PHC services. Conclusion: The findings suggest policymakers and management of People’s Primary Health Care Initiative (PPHI) taking sustainable measures for improving the utilization of PHC services at BHU through ensuring the provision of PHC services.

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