AbstractGiven that government budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments. Nowhere is this need greater than in the health field, where the benefits of programmes are typically difficult to measure. Within the health sector a key area of interest is primary health care, which is generally regarded as a central function and the most important means by which the health of the population can be improved. This paper reports the results of a recent survey of Commonwealth countries which sought to establish the extent of economic evaluation of PHC programmes, the impact on decision‐making and the level of health economics expertise available in Third World countries. Based on the results of the survey, suggestions are made for improving the commissioning and conduct of economic evaluations, for interpreting and implementing evaluation results, and for developing government expertise in economic evaluatio