Worldwide, health care costs are spiralling upwards, forcing health sectors to find alternative organisational structures. Increased global competition and rapid technological and environmental changes are forcing organisations to restructure themselves from rigid bureaucracies towards leaner, more flexible and responsive structures. Aligning traditional health care systems with current transformational needs in South Africa is becoming more and more difficult. This is exacerbated by the growing number of people who live in poverty, the increase in HIV/AIDS cases and their growing dependence on government funding for service delivery. This article explores future prospects for more flexible structures that encourage government "to cope with" and "create change" within the South African health sector. Important drivers in creating the change process are linked to the strategic and policy objectives of the organisat