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The paper's aim is to determine the role of non‐profit organizations (NPOs) in filling possible gaps in primary health care (PHC) service provision.

District (n=10) and sub‐district needs (n=14) analyses were conducted in five South African provinces. In each case, the district/sub‐district manager was interviewed using a semi‐structured interview guide.

The service gaps identified were understaffing/lack of capacity, difficulty in retaining and recruiting staff, service disparities, inaccessibility of services/low‐service utilisation and limited funding. It was believed that NPOs could fill these gaps. About 83 per cent perceived the relationship between government and NPOs as good. Contract monitoring, quality of service, communication and quality control were said to be unsatisfactory. The majority of sub‐districts (11) indicated that they provided supplies to NPOs; 50 per cent perceived the relationship between the sub‐districts and NPOs as good or very good. NPOs have critical role to play in PHC service delivery.

The study provides critical information required to make informed effective strategic decisions that support district/sub‐district performance and sustainability in a decentralized health system.