Upon coming to power in 1994, South Africa's first postapartheid government launched its ambitious Reconstruction and Development Programme with several major primary health care initiatives. Two years later, it adopted a macroeconomic policy that put neoliberal reforms ahead of redistributive goals. Based on ethnographic research in one urban health district, this article examines the consequences of this discordant national policy configuration as manifested in the micropolitics of four community clinics. The article examines contrasting experiences of desegregation in two formerly 'White' facilities, and contrasting community responses to two newly built township clinics. The article finds that, in general, South Africa's neoliberal shift undermined its health policy objectives. However, in exceptional cases where strong nurse leadership combined with relatively uncontentious local class relations, some community clinics did succeed in becoming sites for the local pursuit of health and development goals.