Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) have largely been eliminated in resource-replete countries but remains a problem among the indigenous populations of some of these countries, such as New Zealand and Australia, as well as other less wealthy countries such as those in Africa. The true levels of the disease in southern Africa and the rest of Africa have been poorly documented so far. Recently, a surprising decline has been reported in number of ARF and RHD cases among indigent children presenting to Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa (SA), as well as in Limpopo Province, SA. The decline may be attributed to several factors, including better access to medical care and an improvement in living standards. Eradication of ARF and RHD is therefore nat a simple process and should be addressed at various levels, including making penicillin freely available to treat sore throats, preventing recurrent attacks of rheumatic fever and improving the socioeconomic status of vulnerable communities.