The health services in South Africa have undergone a major reorientation in an attempt to provide the poorest and most vulnerable segments of society with increased access to affordable, quality health care. Unfortunately, the new policies and health plans have not translated into a commensurate improvement of actual health service delivery and health status. A key missing element has been the lack of an appropriate financial planning and budgeting system. This book, Transformation in Action, attempts to fill the void that exists between planning, budgeting and implementation in the public health sector. Drawing on local and international research and policy experiments, it outlines an alternative system called the Performance Budgeting System (PBS). Unlike the current budgeting system, the PBS system integrates financial planning and management with strategic, operational, performance and quality management objectives to ensure that, within budget constraints, service delivery outputs have the greatest possible impact on health outcomes. In so doing, this system can contribute substantially to achieving the objectives of recent public sector reform initiatives and the ideals of the Constitution.