Health care services in South Africa are in decline. Inadequate resources, the fragmentation of services along racial lines, their division between a confused jumble of authorities together with a growing privatization of medical care are among the many factors having grave effects on an already poorly constructed health service. The persistence of high levels of infant mortality and the widespread nature of preventable disease provide clear measures indicating that existing health services have failed to meet the needs of the majority of the population for basic medical care. The changes that are currently underway in health services are making it less likely that they can adequately contribute to providing health for all.