Much has been achieved in just over a decade of democracy in South Africa by facilitating access of the poor to health and other services. However much more needs to be done if the constitutional rights of citizens to dignity is to become universal. Under the strain of an HIV onslaught, second to non in the world, the health systems serving the poor are being incredibly strained. Women in poor communities are having to fill the gap through self devised homed-based care as the public health care system that the vast majority of South Africans rely on is unable to cope. One of South Africa's greatest challenges is to retain and attract skilled and committed workers.