A district health service in Khayelitsha--panacea or pipedream?

Khayelitsha is an underserviced, largely informal urban settlement on the edge of Cape Town. It is home to some 350,000 people. This paper maintains that a district health service would be beneficial in Khayelitsha. Advantages include (i) the integration and co-ordination of services with coherent management of health care; (ii) the ability to prioritise and act on problems with the full range of preventive and curative measures as well as intersectoral support; and (iii) the accountability of health providers. Some of the steps taken towards the initiation of a district health service are illustrated in a discussion of the recent changes in health service structures in Khayelitsha. There are many obstacles to the implementation of a formal district health service and these are discussed briefly.