We attempt to address two key questions in this paper: 1) In terms of state-wide scaling up of rural services in the area of primary health, what will it cost financially and in terms of human resources to scale-up these services in all the rural areas of the state? And 2) what policy, institutional and governance reforms may be necessary so as to ensure proper service delivery? As is well known, merely setting up more health clinics, for instance, is not going to be enough; higher public investments in these areas needs to be accompanied by systemic reforms that will help overhaul the present service delivery system, including issues of control and oversight, for example.