This study explores factors that influenced the policy process for the health sector reforms undertaken by the government. This is a qualitative research, which employs a case study approach. Four cases were selected and, based on a framework for analyzing the policy process, data was collected using interviews, FGDs and document reviews. With the help of a computer-assisted data processing system, the qualitative data was analyzed and findings are presented as four single-case studies. The cross-case analysis generated discussion and a multiple-case study was developed that helped in identifying factors influencing the policy process for the Punjab health sector reforms. The study revealed six factors: (1) absence of clearly defined principles and purposes; (2) insufficient involvement of stakeholders; (3) lack of a holistic view of context; (4) shortcomings of the policy machine; (5) need for a proper implementation structure; and (6) administrative fatigue of donors.