South Africa's first democratic government is today confronted with th
e challenge of recasting apartheid social and health policies, transfo
rming a moribund bureaucracy's mode of governance, and restructuring a
variety of public and private institutions, including the national De
partment of Health. In the attempt to redress racial, gender, and clas
s inequities, enormous barriers confront health policy analysts and pl
anners, progressive politicians, and activists within civil society wh
o work in the field of health. This article sets the broad social poli
cy context for the emerging strategies, documents some of the continui
ng inequities in the health sector, and recounts some recent experienc
es in one of the nine provinces (KwaZulu-Natal), to illustrate the dif
ficulties and potentials that change of this magnitude presents under
the prevailing conditions of neoliberal politics and economics.