Previous studies in South Africa have not dis-aggregated efficiency analysis across municipalities which are health system components of the broader national health system. The purpose of this paper is therefore to assess whether the relative efficiency of South African municipalities in primary health care and hospital care is different and whether South African municipalities can learn from each other to improve on their efficiency. The paper employs efficiency scores, estimated with Data Envelopment Analysis (DEA) using data from the District Health Barometer of the Health Systems Trust to rank South African municipalities across primary health care and hospital health care. The finding is that that the ranking of municipalities is not the same across both types of health care when efficiency scores and efficiency score growth are contemplated. These results imply that municipalities in South Africa are generally inefficient, but with the possibility of learning from each other’s practice in order to increase their technical efficiency. The health system authority should monitor service-specific best practices among municipalities so that they can use them as practice guidelines for other municipalities.