Eastern Cape Province, with a population of 6.4 million, incorporates the former homelands of Transkei and Ciskei. (1) Mthatha (previously Umtata), the former capital of the Transkei, is one of the most economically depressed parts of South Africa. (1) Before 1994, public-funded primary care consisted of rural community clinics and health centres, with basic facilities run mostly by nurses. Medical problems needing further management were referred to district hospitals offering both primary and secondary health care. In 1994, the government opted for a primary care-led system of health care, to ensure equitable access for all. (2) In Mthatha, health centres were upgraded with donor and government financial support. New health centres were developed to serve as a filter for health care between community clinics and district hospitals. All people attending these clinics are triaged by nurses and either managed by them or referred to the doctor at the health centre. Medical problems that require further management are referred to district hospitals.