Johannesburg - Under Section 27 of the Constitution, access to emergency care, including that delivered outside a hospital, is guaranteed for all South Africans.
This means that all medical assistance, including transportation, should be readily accessible to vulnerable South Africans, yet the country’s health sector has fallen short of its objectives. Dr Joe Phaahla, the Minister of Health, explained to a portfolio committee that the country was experiencing a shortage of 3 401 ambulances.
He said that of the 3 342 ambulances available, 750 could not be used due to lack of maintenance or accidents. The international benchmark for ambulance response time ranges from three to seven minutes for life-threatening incidents. For rapid assessment and intervention emergencies, the average time is 18 minutes.
The Gauteng Department of Health (GDoH) reported back in June that the average response time for an ambulance ranged from 30 to 60 minutes, depending on severity. When questioned on the shortage of ambulances, factors contributed included a shortage of personnel, budget constraints, attacks on paramedics and service delivery protests obstructing roads.
“The national norm for Gauteng that stipulates we should have 1,632 (as per population ratio 1:10,000, meaning one ambulance per 10,000 population) plus a buffer of 10% of 163, implying we should have 1,795. Operational ambulances are 1,081; however, with the current staff capacity, we can only roster 300 ambulances daily in the province,” said Kwara Kekana, then spokesperson for the GDoH.
Though the GDoH did procure over 200 ambulance vehicles this year, their response times have not improved, nor has the department managed to successfully fill the gap of staff.
Lungelo Ntombela, an intermediate life support practitioner for emergency services, said the mishandling of resources and lack of regulations from department levels trickled down to the flow of personnel leaving.
He explained that many paramedics and emergency services employees left the sector due to a lack of regulation, resources, and assurances for their safety. Ntombela said that of the paramedics he had worked alongside in his decade of service, those who left felt they couldn’t deal with the overcapacity of patients, many of whom were undocumented migrants in parts of KwaZulu-Natal, Gauteng and Limpopo.
The South African Private Ambulance and Emergency Services Association (SAPAESA) said the public has suffered as a result of these decisions by the HPCSA and the Department of Health (DoH).
“SAPAESA, along with numerous concerned representatives from the Emergency Medical Services industry, predicted this critical shortage of paramedical staff years ago and warned the Department of Health about this likely eventuality in writing during the public comment phase of the Department and HPCSA's plans to end the provision of vocational training to the emergency medical services sector,” it said in a statement.
SAPAESA was accused of embarrassing the then-Minister of Health, Dr Aaron Motsoaledi, when they called out the pending collapse of the sector due to staff shortages. They said with all of this known, the department and the HPCSA still went ahead and terminated the provision of vocational training without having sufficient alternative training resources in place.
“It is no surprise that communities are scared and angry – they do not know whether they will be assisted should a medical emergency befall them. And the communities that are hardest hit are those that cannot afford private medical care or are so rural that they are reliant upon provincial public health services like ambulances,” said Haseena Ismail, MP for the Democratic Alliance.
“Not only are the shortage of EMS vehicles a current headache and danger, but should the NHI Bill be pushed through Parliament, the impact on the already overburdened public health system will be severe. About 1 685 people lost their lives in road accidents during the 2021 festive season. How many could have been saved had the country’s EMS been fully capacitated?” she said.