The health of the nation is characterised by a quadruple burden of disease, with the impact of HIV/AIDS adding to the combination of a high injury burden, conditions related to underdevelopment and chronic diseases. Per capita spending at district level on Primary Health Care (PHC) ranges from R389 in richer districts to R42 in the poorest districts, meaning that many districts are simply not able to afford the PHC package estimated at approximately R220 per capita. Although spending on health in the public sector in 2005/6 is projected to increase by R 8.7 billion in real terms over a decade, much of the funding has been absorbed by HIV/AIDS, medical inflation and relatively higher salaries which has resulted in real expenditure per capita stagnating. These are some of the findings contained in the 9th South African Health Review (SAHR).