Background: The population in developing countries is ageing, which is likely to increase the burden of non-communicable diseases and disability. Objective: To describe factors associated with self-reported health, disability and quality of life (QoL) of older people in the rural northeast of South Africa. Design: Cross-sectional survey of 6,206 individuals aged 50 and over. We used multivariate analysis to examine relationships between demographic variables and measures of self-reported health (Health Status), functional ability (WHODASi) and quality of life (WHOQoL). Results: About 4,085 of 6,206 people eligible (65.8%) completed the interview. Women (Odds Ratio (OR)=1.30, 95% CI 1.09, 1.55), older age (OR=2.59, 95% CI 1.97, 3.40), lower education (OR=1.62, 95% CI 1.31, 2.00), single status (OR=1.18, 95% CI 1.01, 1.37) and not working at present (OR=1.29, 95% CI 1.06, 1.59) were associated with a low health status. Women were also more likely to report a higher level of disability (OR=1.38, 95% CI 1.14, 1.66), as were older people (OR=2.92, 95% CI 2.25, 3.78), those with no education (OR=1.57, 95% CI 1.26, 1.97), with single status (OR=1.25, 95% CI 1.06, 1.46) and not working at present (OR=1.33, 95% CI 1.06, 1.66). Older age (OR=1.35, 95% CI 1.06, 1.74), no education (OR=1.39, 95% CI 1.11, 1.73), single status (OR=1.28, 95% CI 1.10, 1.49), a low household asset score (OR=1.52, 95% CI 1.19, 1.94) and not working at present (OR=1.32; 95% CI 1.07, 1.64) were all associated with lower quality of life. Conclusions: This study presents the first population-based data from South Africa on health status, functional ability and quality of life among older people. Health and social services will need to be restructured to provide effective care for older people living in rural South Africa with impaired functionality and other health problems.