A recent labour dispute involving emergency medical service (EMS) workers in the Eastern Cape has once again put the province’s chronic EMS problems in the spotlight.

Spotlight and other publications have in recent years often reported on the province’s ongoing ambulance shortages and patients sometimes resorting to private transport in emergencies. In May 2021, a controversial scooter ambulance tender in the province was set aside.

Shortage of ambulances and paramedics 

The province’s health department confirms the ongoing shortage of ambulances and blames it on funding shortfalls and the poor state of provincial roads that are riddled with potholes.

Department spokesperson Sizwe Kupelo says the province’s EMS should have 650 ambulances, but only has 439. He says the province has 181 patient transport vehicles and 41 rescue vehicles. 

He says “190 (of the 439) ambulances have broken down due to various faults. For alternative transport and to reach inaccessible areas, the department has to use helicopters to transport patients to the nearest hospital.”

The province has 2,173 EMS crew members – 1,377 basic ambulance assistants, 730 intermediate life support workers and 66 who are qualified in advanced life support. The Sarah Baartman District has the most advanced life support paramedics (14), followed by the Buffalo City Metro (13) and Nelson Mandela Bay (nine). The remaining districts have between three and eight.

With the start of the holiday season, the provincial health department revealed that the Eastern Cape only has 439 ambulances, when it should have 650. (Photo: Luvuyo Mehlwana / Spotlight)

“The shortage of ambulances is based on the funding envelope that is available to the department. We require additional funding for the recruitment of emergency care officers and paramedics and for the leasing of additional vehicles to reach the desired number of 650 ambulances to meet the demands of the province,” he adds.

Labour dispute

The province’s EMS problems are further complicated by tensions with trade unions.

In May 2022, Spotlight first reported on a labour dispute disrupting EMS services in the Amathole and King William’s Town areas. That situation has not been fully resolved and the province’s health department is now seeking to fire 224 EMS workers in those areas.

The workers had embarked on what Spotlight understands to have been an unprotected strike from April 2022 to November 2022, alleging, among other things, that ambulances were not sufficiently equipped with essential tools. When Spotlight previously reported on the matter, a National Education, Health and Allied Workers Union (Nehawu) spokesperson denied that the workers were striking. The strike affected EMS services mainly in the rural areas of the Amathole District where desperate villagers pooled their resources to hire private cars to get to healthcare facilities.

While the strike ended in 2022, related disciplinary processes are ongoing. 

“The matter was referred to a disciplinary hearing where the employees have been dismissed by the presiding officer and they have appealed their dismissal, and we will await the outcome of the appeal authority on this matter,” explains Kupelo. “They are back at work and working in line with the disciplinary code and procedure.”

Read more in Daily Maverick: Only 300 of Gauteng’s 1,081 operational ambulances are on the road due to staff shortages

Lulamile Sihunu, the Max Madlingozi regional secretary of Nehawu, confirms that the union has appealed the workers’ dismissal, and they are waiting for a hearing date.

“The department is the one that chooses the vehicle and needs to make sure it is a vehicle that will be able to drive in rural areas. The Eastern Cape has no ambulances, and Alice has only one ambulance instead of 10. Most of the EMS bases in the province are in a sorry state, the equipment is lacking, so workers are demoralised. If workers complain about the poor state of EMS, managers threaten to charge them with misconduct,” Sihunu says. 

The Eastern Cape’s EMS problems are further complicated by labour disputes, with the province’s health department seeking to fire 224 EMS workers in the Amathole and King William’s Town areas. (Photo: Luvuyo Mehlwana / Spotlight)

Poor road conditions blamed

In her department’s annual report to the provincial legislature, Eastern Cape health MEC Nomakhosazana Meth attributed the shortage of ambulances to poor road conditions in rural areas.

“The department’s ambulances are experiencing difficulties on rural roads, leading to serious damage. However, there are ongoing challenges in repairing and maintaining vehicles, leading to lengthy turnaround times. Collaborative efforts with the Department of Transport have been made to address this situation and expedite vehicle repairs, however not bearing the desired results. This leads to departmental ambulances being repaired for prolonged periods of time,” reads the report.

The report explains: “The delivery delay of 16 rescue vehicles remains problematic, and response vehicles are being utilised temporarily until their expected arrival in the second quarter of the new financial year.”

EFF MPL and health portfolio committee member Simthembile Madikizela agrees that the poor state of roads contributes to ambulance breakdowns as most state vehicles are always having suspension problems.

Eastern Cape health MEC Nomakhosazana Meth (left) during the Arrive Alive campaign for the festive season in 2022. (Photo: Luvuyo Mehlwana / Spotlight)

“It is worrisome that there is a shortage of ambulances, as some places don’t have access to ambulances at all because of the long turnaround time for servicing,” Madikizela tells Spotlight.

Read more in Daily Maverick: Healthcare in Mpumalanga hamstrung by ambulance shortages and other problems

“Therefore, it would be beneficial to have our own in-house maintenance centre because some of these ambulances are just experiencing suspension problems. With our own maintenance service, if an ambulance breaks down today, it can be back on the road within two days instead of taking three months to be repaired,” Madikizela says. “It will remain impossible to provide an ambulance for every 10,000 people under the current situation. In rural areas, ambulances are allocated based on the population of the district.”

Kupelo says all districts, not only rural ones, have challenges with turnaround times for the maintenance and repair of vehicles. 

“The vehicles are rented from the Department of Transport and Government Fleet Management Services under the Department of Transport. The same department manages the repair and maintenance of our emergency fleet,” he says.

Poor performance is ‘killing citizens’

Jane Cowley, DA MPL and health spokesperson in the province, says the health department’s poor performance is killing citizens. 

“I shall once again write to the Minister of Health, Dr Joe Phaahla, to urge him to place this department under administration in terms of Section 100 (1) (b) (i) of the Constitution until such time as the minimum standards for health service delivery can once again be met,” she says.

“The provincial health department is in crisis, and based on the latest Auditor-General report, there is still no political will to fix it. The report for the 2022/23 financial year, presented to the health portfolio committee, brings into stark view a department in deep, deep trouble. The AG found that the department’s poor financial performance was, among others, contributing to the deaths of pregnant women and children within health facilities.”

The poor conditions on many rural roads in the Eastern Cape as well as funding shortfalls are being blamed for the shortage of ambulances in the province. (Photo: Luvuyo Mehlwana / Spotlight)

Residents of Xhora Mouth depend on government ambulances to get them to the nearest hospital, but if an ambulance doesn’t arrive in time they have to pay for private transport. (Photo: Black Star / Spotlight)

Residents sometimes pay for own transport to hospitals

Spotlight has reported on how women in Xhora Mouth are giving birth at home or at the back of hired transport due to a lack of EMS. Residents there depend heavily on government ambulances to get them to Zithulele Hospital, the nearest hospital, about 39km away. If an ambulance fails to arrive in time they have to pay between R400 and R700 for private transport for a one-way trip to the hospital.

Read more in Daily Maverick: New ambulances for Northern Cape but critical vehicle, staff shortages persist

Poor access to EMS is a longstanding problem in many rural areas of the province, but the lack of ambulances and slow response times are not limited to those areas.

The acting CEO of Jose Pearson TB Hospital in Gqeberha, Siziwe Ntsabo, told MPLs during an oversight visit on 7 September this year that the hospital has challenges when it comes to EMS.

“The EMS don’t arrive on time. At worst, the ambulance will show up after two days. Our patients miss important specialist appointments and reviews at the hospital as they are dependent on EMS to bring them for review. We had tried to meet with EMS management to discuss the ambulance shortages, but they kept on shifting goalposts,” she says. DM

This article was produced by Spotlight – in-depth, public interest health journalism.