Existing literature on health inequalities often overlooks the nuanced dynamics, particularly among vulnerable children with chronic diseases and disabilities and fails to consider regional disparities within countries like South Africa. This paper asserts the necessity for a more granular analysis in South Africa, recognizing the varied health outcomes for children across different economic segments and geographical settings. Specifically, the health trajectories for children differ markedly between rural formal areas, regions under traditional authorities, formal urban areas, and informal urban settlements. Addressing the generalizations common in prior research, this study takes a precise, regionally focused approach to socio-economic-driven disparities in chronic illness or disability. It distinguishes between rural formal areas, traditional authority areas, formal urban areas, and informal urban areas, unveiling the intricate layers of health disparities. Using data from the National Income Dynamics Study, concentration indices, and the Oaxaca-Blinder Decomposition method, the paper analyzed health inequality trends from 2008 to 2017. The results uncover significant inequalities, with alarming trends, particularly among children with chronic illnesses and disabilities in traditional authority regions and informal urban environments. The paper's evidence shows that rural formal areas have experienced a decline in health disparities as opposed to the deepening divide in traditional authority-led regions. The urban analysis reveals a split: while formal urban settings often favour the wealthier, informal urban areas indicate a shift towards lower socioeconomic brackets. The decomposition analysis highlights the evolving socioeconomic elements influencing each region over time. These insights emphasize the urgent necessity for geographically tailored policy interventions. By understanding the distinct socioeconomic landscapes across various regions, we can formulate policies that resonate with each area's specific realities and challenges. Such targeted strategies are essential in reducing health inequalities and enhancing the life quality of children with chronic health conditions and disabilities, playing a critical role in South Africa's journey toward comprehensive health equity.