OBJECTIVE： To provide reference for promoting the rational use of essential medicines in primary medical institutions. METHODS： Twenty six rural primary medical institutions （13 township health centers， 13 village clinics） were randomly selected from 2 poverty-stricken county （city） in Huanggang city of Hubei province. The utilization of essential medicine was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS： The utilization rate of essential medicine in sample township health centers was 76.9％， and the amount of essential medicine accounted for 93.0％； the utilization rate of essential medicine in sample village clinics was 89.7％. The utilization rate of variety from essential medicine list was 53.6％ in sample township health centers and 25.0％ in sample village clinics； the utilization rate of variety from National Essential Medicine List was higher than that of Provincial Essential Medicine List Supplement. The amount of 5 major categories as antimicrobial agents， cardiovascular agent in sample primary medical institutions accounted for 64.7％ of chemical agents. The top ten medicines in the list of amount were all essential medicine， 9 of which were national essential medicines. There were 2.8 kinds of medicines in each outpatient prescription averagely in sample township health centers. The proportion of antibiotic prescription was 44.2％. CONCLUSIONS： The utilization rate of essential medicines in township health centers of this area is lower than WHO recommended value， and the ratio of amount meets the policy requirements. The utilization rate of variety from Provincial Essential Medicine List Supplement is in low level in primary medical institutions； the amount of anti-microbial drugs is in high level； the rationality of medicine use in prescriptions needs to be improved. It is suggested to adjust the type of provincial supplement list dynamically according to actual situation and control the price and amount of main categories strictly， the rationality of prescription.