The last 5 years have seen dramatic developments in South Africa, with wide-based internal political struggles and international pressure forcing the government into a well publicized if temporary series of reforms. Yet this has not been paralleled by any substantial improvement in the health conditions of the majority of the population. Apart from improvements in black infant mortality in some urban areas, the health gap remains, a material expression of the social inequality that is part of the definition of apartheid. Black children continue to die from preventible afflictions at about 10 times the rate of their white counterparts. Maternal deaths among women classified as black, coloured or Asian continue to occur, mostly due to septic abortions. At national level, blacks are nearly 30 times more at risk of being diagnosed to have tuberculosis than whites, with some age groups being at still worse risk. Black children under the age of 4 years in Cape Town in 1984 were 205 times more likely to have tuberculosis than their white counterparts. The last 5 years has also seen a revival of rhetoric echoing the international support for primary health care in the 1970s, but health care processes have not been modified to cope with the continuing racial stratification of disease and access to health care. A move towards privatization of the health services has only benefited a few.