Using a multi-level perspective, this paper examines the structural constraints and conflicting perspectives affecting the implementation of Primary Health Care (PHC) in Zimbabwe. The analysis of these factors and processes is made by viewing the situation from the different perspectives, perceptions and actions of the state, the health workers and the population. It is argued that the continuing structural inequalities, the bureaucratic and centralization tendencies, the historical development and colonial transplantation of biomedical practice, and the de facto lack of support by government, constrain the implementation of PHC.