Introduction The evaluation research was conducted to establish the role of primary health care in the process of rehabilitation, activation and employment of the long-term unemployed citizens. Empirical data was gathered from 17 municipal projects. Projects aimed to develop health care services for the unemployed and to improve co-operation between health care services and local activation and employment services. Theory The theory of transitional labour markets was used as a framework for the evaluation . The aim of activation is to encourage people to make transitions towards the labour markets or other desired activity (education, pension etc.). Health care services were constructed as one possible factor enabling transitions from unemployment. Inter-agency co-operation between state and municipal actors is crucial in activation processes. Methods The research was conducted from the perspective of process evaluation. Data consists of surveys, interviews and case-studies. Data from the surveys was analyzed with SPSS using descriptive statistics. Content analysis was used for the qualitative data. Results and conclusions Many of the long-term unemployed clients needed health care services and counselling besides social and employment services. Transitions to rehabilitation or pension become possible only after a medical assessment of persons' working ability has been made. During the evaluation period transitions to work, rehabilitation or pension were very rare among the clients. Co-operation between primary health care and activation services improved during the projects. The public health nurses in the projects worked as case-managers. The level of integration of health care services and activation services varied in the municipalities. The role of primary health care is important in recognizing health factors that can hinder employment and in initiating rehabilitation processes.