Kayelitsha 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 then towards the initiation of a district health service are illustrated in a discussion of the recent changes in health service structures in Kayelitsha.

There are many obstacles to the implementation of a formal district health service and these are discussed briefly.