Background: Pneumonia contribute 15% child deaths across world with 20% of it in India. WHO recommend PO use in routine care for children for early detection of pneumonia in LMICs, however, India IMNCI lacks. Objective: To assess feasibility and acceptability of introducing PO in IMNCI services at Primary Health Center (PHC) in rural Pune district. Method: Medical officer (MO) and auxiliary nurse midwife (ANM) identified from six PHCs as study participants being involved in treatment of children. IDI guides developed for MOs and ANMs to understand their IMNCI knowledge and attitude towards program. PO module added to understand perceptions about it usefulness to diagnose pneumonia. After baseline, training sessions on adapted IMNCI services including PO use conducted for MOs and ANMs. PO device provided at study PHCs. Result: Baseline, no PO device used at study PHCs; PHC staff reflected satisfactory knowledge about pneumonia- demanded refresher IMNCI training; need to reiterate the PO use and early diagnosis of pneumonia in children; enlisted challenges encountered in management of pneumonia at PHCs- system-related and parents? attitude towards care seeking. Positive acceptance of training and immediate use of PO in PHCs. Endline, confidence to use PO boasted post intervention. PO use in examining symptomatic children increased from 26 to 85%. Conclusion: PO implementation could be integrated at PHC level successfully. Pre-implementation training and provision of PO to PHCs found helpful. Intervention demonstrated that an organized method to diagnose pneumonia in children could improve case management.