Background: universal health coverage and the health-related sustainable development goals can only be achieved with a stronger emphasis on Primary Health Care (PHC). In spite of the essential role of clinical governance (CG) in enhancing quality of services provided by PHC facilities, a scientific framework with precise criteria for evaluating them has not been developed so far in Egypt. Objective: to assess the CG in PHC in Egypt considering PHC of Al-Dakahlia governorate as a case study and to clarify the barriers for implementing CG at PHC. Subjects and Methods: a cross sectional study was conducted over a period of one year at 8 PHC facilities in selected two districts; Al-Sinbelawin and Aga in Al-Dakahlia governorate, Egypt. The assessment of CG indicators was through multi-level approaches from different perspectives of 327 PHC utilizers, 40 PHC providers, 10 PHC executive directors who were drawn from the selected districts. Thirteen experts in PHC and CG in Egypt were also participated. Results: CG index for PHC facilities was scored higher percentage degree by PHC directors (91.0%) than by PHC utilizers, providers and the experts (70.0%, 59.6% & 53.3% respectively). The CG indicators showed disparities between the participating groups. Experts reported several challenges for CG implementation as shortage of clear policies, lack of awareness about governance culture and lack of experience in this field. Conclusion: the successful CG framework should be based on plan & implement as a team and create better relationships between directors and all stakeholders.