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The 1970s and 1980s bore witness both to a consolidation of the controversial bantustan system in South Africa – accompanied with the notorious neglect of key services such as health care in these areas by the apartheid state – and the revival and development of a radical global vision of primary health care encompassed by the World Health Organisation's mandate of ‘health for all’. This paper describes the influence of these diverse forces on mission hospitals operating in the ‘homeland’ of KwaZulu, which were eventually taken over by the KwaZulu government. While existing literature about the bantustans has tended to focus on the enormous financial constraints and the inadequacy of service provision, I argue that the period of ‘homeland’ rule in fact provided a certain degree of autonomy from the prescriptions of the central state, along with a relative increase of funds which, though inadequate, nonetheless created an opportunity for these hospitals to develop and implement a progressive model of community-based care. By using this example, I do not intend to challenge the many indisputable critiques of ‘homeland’ rule, but rather to suggest that some of the nuances of its diverse operations may have been overlooked as a result of the polemical approach of earlier scholars. [ABSTRACT FROM PUBLISHER]