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Background Since the new medical reform, primary health care institutions have made remarkable achievements in the number of consultations and basic public health service projects, however, the problems including low quality and high mobility of personnel, weakened capacity and low efficiency of service still remain. Therefore, it has become an urgent task to solve the development dilemma of primary health care institutions. Objective To analyze the development dilemma of primary health care institutions and propose corresponding countermeasures. Methods From April to May 2021, the heads of 16 primary health care institutions in 6 counties and 2 districts in Guilin were selected using multi-stage sampling method to conduct semi-structured interviews, which mainly included resource allocation, service capacity building, health insurance policy implementation, and development dilemmas. NVivo 11.0 qualitative analysis software and the research method of ground theory were used to classify, ummarize and refine the original interview data at each level. Results A total of 38 initial concepts, 9 initial categories, 4 main categories, and 1 core category were extracted, and nodes of stagnation in four dimensions including "resource allocation constraints" "obstruction of the path of three medical linkage" "deviation of functional positioning" and "accessibility lacking in medical community construction" were obtained. Conclusion The development of primary health care institutions is constrained by a variety of factors, with resource allocation balance and compensation mechanism improvement as core issue, synergy of the three medical linkage paths as external condition, adjustment of functional positioning as key link, and the construction of close medical community as important approach.