The intent of this research study is to pellucid the dynamics of Healthcare Reform system of Medical Teaching Institutions in Khyber Pakhtunkhwa and to analyzed the effects of reforms over the institutional performance and growth in provision of quality Health Care Services to the people of localities. The Medical Teaching Institutions healthcare reforms system has been scanned with the lenses of Policy design, autonomy dimensions, Governance & Accountability pattern with practices in order to diagnose and gauge the prevailed constraints increasing risks which affecting the performance , sustainability and growth of the system. In addition to this, the study also articulate the blurred concepts of autonomy exercised at the field level and its impact over performance in context of pre and post scenarios. The qualitative research strategy techniques have been applied with a tools of semi structure interviews, observation participant and focus group discussion to get primary data. In Khyber Pakhtunkhwa such type of study is unique in nature as no such type of study has been conducted at MTI Reforms in the specific context. The findings of this research insights the trajectories of the Medical Teaching Institutions reforms system according to its values and differences prevailed at the implementation level which intercept and paced the success of these reforms as intended by the policy makers. The study extracted that although the system positively impacted the performance of hospitals to the extent of responsiveness however yet it will take time to achieve its objective of quality health care services provisions according to international standards. The governance of the system faces the lack of Coordination, Cooperation and Commitment among the stakeholders. Besides this, duality and complexity of the system expended due to weak policy designing. Similarly the efforts to balance control over autonomy hampered the autonomy values of the system. The recommendation of this research torched those areas and will channelized the whole system according to its true values and the system will accelerate its velocity towards its objectives. Supervisor:- Dr. Talat Anwar