South Africa emerged into democracy in 1994 with extensive disparities characterizing every aspect of its social and economic life.  Its highly developed health system was no exception, providing world-class tertiary hospital based care for the few to the near universal neglect of primary health care for all.  The EQUITY Project was challenged to redress this imbalance, starting in the poorest province of Eastern Cape.  From an in-depth baseline assessment, followed by annual measurements of disparity in health services, the Project attempted to reallocate resources and efforts to achieve health equity.
The development of a dynamic health information system by grass roots workers became a pivotal tool to raising awareness and directing remedial actions where needed the most.  The HMIS developed nationally and “dropped” on the services was cumbersome, burdensome, generally inappropriate and unreliable. When re-developed from below, with indicators seen as relevant and actionable, eliminating data elements of no use to local decisions, analysed and graphed by the people collecting the data, the District HIS became a dynamic tool for health action and disparity reduction.  The approach spread “upward” from clinics to hospitals involving not only key service data but also client satisfaction surveys, financial management and drug logistics, providing essential information for decision makers at all levels. Principles of developing such a system and pitfalls will be presented and discussed.