As an MCP, I have to put in a word for MS Visual Studio .NET. You have a choice 
of languages, designed-in access to SQL Server, and the framework is designed 
from the get-go to enable creating Web services, which will allow you to write 
an application which can be both an n-tier desktop app and a Web-enabled app. 
Just my $0.02...

That said, I think that I should bring up something that doesn't seem to have 
been addressed as yet: legal constraints. I do not know the laws of South 
Africa in this regard, but writing such an application here in the States 
requires careful consideration of and compliance with two pretty significant, 
and possibly bad-nasty acronyms--SOX and HIPAA. That is, Sarbanes-Oxley and the 
Health Insurance Portability and Accountability Act. 

Applications meant to operate in the environment for which this application 
appears to be targeted must meet some pretty stringent, and quite complicated, 
requirements for compliance with these acts. There is, indeed, an entire 
industry built around bringing existing systems into compliance as required by 
law. Google on either and you will see what I mean. Again, I don't know if 
there are parallels in South Africa, but I do think that it is something which 
you should investigate and determine before considering what tool to use or how 
you plan to structure your system.

FWIW, I'm an MCP with decades of programming experience in multiple languages, 
and I don't think I would want to try to tackle this alone. A system like this 
cries out for a business analyst, requirements analyst, database administrator, 
and system architect, as well as a quality control and testing team. All of 
that besides the developer(s), of course. It is possible for one person to play 
all of those roles for small-to-medium applications, but be aware that from the 
description of it you're talking about a significant application here, and at 
different times *someone* is going to have to fulfill each of those roles. 
Working alone, you will also have to be your own business agent, negotiator, 
and project manager. How many hats have you got? Have fun!  ;-)

Cheers,
Scott

P.S. Keep in mind that this will be a *very* data-intensive application. How up 
are you on SQL, data normalization, etc.? 
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