The paper focuses on five central features of health policy in South Africa. These are: (1) the differential expenditure on the health services for Whites, Coloureds, Indians and Africans; (2) the inequality between rural and urban African health services; (3) the structure and financing of rural health services for Africans; (4) the recent restructuring of the urban health services for Whites, Coloureds and Indians under the New Constitution; and (5) family planning policy. In each case the policy cannot be adequately explained merely as a symptom of the differential access to political and economic power: health services are also instruments of the state in achieving Apartheid goals. Firstly, the health services aid in the reproduction of the Black labour force according to White economic needs. The provision of health care for Blacks outside the bantustans is geared towards the urban population as the supplier of a large and increasingly skilled, Black workforce, rather than the Black population at large. Secondly, the health services support the commitment to ‘separate development’ in various ways. They reproduce an ideology which legitimizes Apartheid. Within the bantustans, they are an important factor in inducing ‘surplus’ Africans from ‘White’ areas to return to the bantustans. They help to establish the credibility of the bantustans and their leaders, and of the representatives in the new segregated parliament. They also provide a lever with which the government can pressurize bantustan governments into accepting ‘independence’. Thirdly, the health services are part of a strategy to co-opt some Blacks while dividing the opposition. Thus health policy is shown to be an instrument of the state's twin imperatives: reproducing the conditions of capitalist accumulation and maintaining White supremacy.