Provinces’ ambulance services running on empty

SA has fewer than half the ambulances it requires to meet the population’s needs, health minister Joe Phaahla has revealed to parliament. The desperate shortage means patients who need urgent care face long delays, placing lives at risk.

The government aims for a ratio of one ambulance per 10,000 people on average, but due to staff shortages, provincial health departments are operating only 49% of the 6,824 ambulances needed to meet this target, the minister’s response to questions posed by DA MP Haseena Ismail shows.

“Without ambulances, people die. 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 on provincial health services,” Ismail said.

Business Day’s analysis of the figures the minister provided to parliament show the North West is in the worst position, operat

ing only 70 (18.9%) of the 370 ambulances it needs, followed by the Western Cape, which is running just 120 (21.1%) of the 570 ambulances it requires. Gauteng is operating 1,600 ambulances, representing 62% of the 2,592 it needs to meet the government target, KwaZuluNatal is operating 432 of the 1,174 ambulances it requires, and the Eastern Cape has 448 of the 670 it needs.

The minister said 967 ambulances were out of commission due to accidents or routine maintenance and repairs.

Phaahla did not detail the reasons for the ambulance shortfall in his response to Ismail, who said she believed several factors play into the shortage. “As far as we understand, the problem is layered. Budget allocations are not managed as well as [they] should be, and diligent maintenance of ambulances is lacking.

“Another aspect seems to be paramedic shortages and the outsourcing of emergency medical services to private companies.”

Ismail said a full grasp of each province’s shortages would require further interrogation, and she plans to ask follow-up questions.

Western Cape health department spokesperson Mark van der Heever said the province has 258 licensed ambulances, but has enough personnel to run only 120 of them round the clock. It has 41 ambulances in for repairs or maintenance, leaving it with a buffer of 97 ambulances that it could use if it had more personnel.

The provincial health department could mobilise off-duty personnel in a disaster, but could not routinely run more than it is doing now with its current staff complement, he said.

Phaahla indicated that several other provinces have buffer ambulances in their fleets, suggesting they have the potential to operate more vehicles if they had the requisite staff. These include the Free State, Eastern Cape, Gauteng and Mpumalanga.

Health department spokesperson Foster Mohale said the number of available ambulances depends on budgets, and the ratio of one ambulance per 10,000 population is just a guide. The size of the catchment area, the percentage of the population with health insurance, the distances to hospitals and the healthcare needs of the population affect the demand for ambulances. A smaller area, less distance to hospitals, greater medical insurance coverage and access to transport may reduce the ratio to as low as one to 30,000 population, he said.

DUE TO STAFF SHORTAGES, PROVINCIAL HEALTH DEPARTMENTS ARE OPERATING ONLY 49% OF THE 6,824 AMBULANCES NEEDED