Apart from a dire lack of funding, a nonchalant attitude from authorities is blamed for exacerbating working conditions for paramedics countrywide, who are battling with ambulance and equipment shortages, and increasingly inadequate emergency care for communities.
In a recent parliamentary response, Health Minister Aaron Motsoaledi acknowledged that staffing levels could not cope with 63m people, while overworked EMS personnel grievances include insufficient vehicles, and those that are operational being unsafe and dirty; a lack of basic equipment, and a “don’t care” attitude from management.
And while KwaZulu-Natal alone might have 480 ambulances on its books, 240 of these are out of commission. The Eastern Cape is in a similar boat, with 418 ambulances but 125 of them non-operational, reports IOL.
Nationally, the ambulance to population ratio is 1:10 000, with just 14 000 operational EMS personnel as of 28 February this year.
State paramedics from the Northern Cape and the Eastern Cape have consistently voiced concerns over chronic ambulance shortages in those areas.
Some towns in the Northern Cape have no ambulances or even staff: one town has a single dilapidated ambulance with suspension issues, but staff are forced to use it or face unpaid leave or being booked absent without leave. “I wouldn’t even allow my dog to travel in a vehicle like that,” said one.
Unsafe conditions
The many issues with the ambulances are compounded by the basic lack of cleaning materials with which to clean or sanitise the vehicles, which are run 24/7, and passed from one shift to the next.
“In 2006, we had more than 15 ambulances per shift. We are down to about six, depending on breakages and servicing.”
In one town, two ambulances cover about 300 000 people, said a paramedic. “One day, I transported 16 people in the vehicle because I could not leave anyone behind. They were serious cases.”
He recalled having to stop at the side of the road and offload patients to deliver babies. “These people must them get back into an ambulance where the amniotic fluids and stuff is all over the place, including blood… the management just can’t be bothered.”
He said cross-contamination was ongoing because there is no time to sanitise the ambulance between calls, and no proper cleaning equipment.
“I have to use a mop and water to clean up blood because there is no soap.”
A few years ago, he said he was assaulted when he arrived late for a call – due to the ambulance shortage – and the patient had already died.
“When the government launched 22 new ambulances recently, we did not receive any, despite our challenges,” he added.
Equipment, resource deficiencies
Badly equipped, the ambulances lack basic equipment – like drips – most of which is broken or missing. “Some of us have to buy our own things like blood pressure cuffs and stethoscopes, etc.
“Besides damaged equipment, ambulance roadworthiness is worrying because of worn tyres, broken windows, malfunctioning tail- and head-lights and so on.”
Another paramedic from the Eastern Cape said they have been fighting over ambulance and staff shortages since 2023. “We have to work double shifts, and you get eight people on a shift sharing one ambulance to cover three towns plus farm areas, and taking transfers to other towns as far as 200km away.”
Public outcry and union responses
There was increasing anger from the public, and the potential for rising medical claims and fatalities among emergency medical officers, he warned.
The South African Emergency Personnel’s Union (SAEPU) president Mpho Mpogeng said that while all provinces were badly affected, Mpumalanga and the Northern Cape had the most significant challenges.
Mpogeng also noted that Gauteng was abusing the internship system. “The province is operating with 80% internship programmes because of the staff shortages …People think the province has enough staff and is rendering proper service; that is not so. It has ambulances but no staff.”
He said people could wait for an ambulance for three to four hours, resulting in needless deaths, but the stipulated response time was supposed to be five minutes.
Critical positions only
Public Servants Association spokesperson Claude Naiker said all of the provinces have chronic staff shortages, because the department had filled only what it deemed to be “critical positions”.
He added that although the Eastern Cape had bought 447 ambulances, only 260 are operational – because there aren’t enough staff to man them.
“Similarly, the Western Cape has only 120 new ambulances operational, for the same reasons.”
In many instances, communities have to hire private cars to take people to hospital.
The Health and Other Services Personnel Trade Union of South Africa (Hospersa) said staff frequently relied on a rotation system with the ambulances.
“For example, in the Sarah Baartman District, if one ambulance is taking a patient to a hospital in Gqeberha (Nelson Mandela District), the remaining ambulance cannot serve the community and must remain on standby until the first returns.”
Insufficient funding within the Department of Health, added the union, was hindering matters, with staff consistently being compelled to work monthly overtime.
“But the impact … is severe. They work extremely long hours without adequate rest, and overtime payments are often delayed and only processed after repeated complaints.”
Hospersa said the psychological toll on staff is also significant: there is no psychosocial support available to help them cope with the stress and trauma of their work.
Government response and oversight
Health Portfolio Committee chairperson in the KZN legislature Imran Keeka said the concern around ambulances was not new, and that the committee had made emergency medical services a priority.
On a typical day, KZN has fewer than 240 vehicles travelling on its roads, he said.
“I have had anecdotal reports where, for example, for the entire eThekwini district, on some days only five to 10 ambulances are working. Some are used as glorified taxis for inter-facility transfers.”
He described the ambulance fleet as “aged”, adding that because they often travel over challenging terrain, there are frequent breakdowns.
Last year, when he asked KZN Health MEC Nomagugu Simelane how many Emergency Response Services vehicles were in for repairs in each district, she said in all 11 districts, 310 vehicles had mechanical problems, and 18 had been crashed.
In addition, 134 planned patient transport vehicles had mechanical issues, while 15 were involved in accidents.
EThekwini had 72 emergency vehicles with mechanical repairs, the highest out of all the districts.
On whether repairs would take longer than than 60 days, the MEC said reasons for delays included “back orders for unavailable parts”, and some vehicles having extensive accident damage that delayed repair time.
At the time of the response, KZN had 26 ambulances and 40 public transport vehicles that had been in for repairs longer than 60 days.
In December, the portfolio committee conducted oversight visits to four provincial districts and visited six facilities in KZN.
The committee was concerned by various equipment shortages, including of disposable items like bandages, gloves and splints, and incubators, as well as infection prevention control cleaning materials for vehicles.
The Department of Health did not respond to several requests for comment.
See more from MedicalBrief archives:
Pietermaritzburg ambulance shortage at crisis point
SA short of thousands of ambulances
Patients suffer as Eastern Cape ambulance crisis remains unresolved
‘As much as a third’ of Eastern Cape ambulance fleet in for repairs