(Photo: Donna van der Watt) 
The Eastern Cape Department of Health confirmed on Tuesday that due to dire staff shortages in Nelson Mandela Bay’s emergency services, it now has to rely on private ambulances for assistance as it can keep only 15 ambulances on the road.
That’s fewer than half the available 36 vehicles. This marks a regression from 2015, when 16 staffed ambulances were operational, despite a South African Human Rights Commission investigation into the EMS crisis in the province and metro that year.
Department spokesperson Siyanda Manana confirmed that low staff levels meant that only 15 vehicles could be run. “Sometimes we use private operators when there is no ambulance available,” he said. “We also use private operators for critical patients when there is no ambulance available.”
He did not respond to questions about the reasons for the dire staff shortages.
Nine months ago, when the Eastern Cape Legislature visited Nelson Mandela Bay during an oversight visit to the ambulance call centre, legislature members said there was a problem with the organogram – the staffing did not correspond with service delivery demands. At the time, only 15 vehicles were operational.
Back then, the legislature asked that a new, fully financed organogram be developed. About 1.3 million people live in Nelson Mandela Bay and, according to National Department of Health standards, should have 120 to 130 operational ambulances.
SAHRC order
In 2015, the South African Human Rights Commission ordered that the problem be addressed. At the time, the Nelson Mandela Bay metro was ranked as the worst off in the province.
“While the Nelson Mandela Metropolitan Municipality hosts the second-biggest population in the province, it has the smallest number of operational ambulances,” said the SAHRC report at the time.
The SAHRC recommended that the implementation and measurement of compliance with national standards for emergency medical services should be “applied consistently in all planning and reporting documents”.
The report said the “Eastern Cape Department of Health, in collaboration with the National Department of Health, should review recruitment strategies aimed at attracting new EMS practitioners in the province, and particularly in the rural area[s].”
The commission said the funding and employment of call centre staff should be prioritised, as should the training and recruitment of EMS staff with intermediate or advanced life support training.
Now, the SAHRC is applying for a court order to force the department to take action on its recommendations.
On 16 April 2025, the commission instituted civil proceedings against the Department of Health concerning the lack of EMS in the Xhorha Mouth area, as well as the department’s failure to comply with the commission’s 2015 EMS report. According to the Notice of Motion, the matter was scheduled to be heard on 20 May 2025 in the High Court, Bhisho. It is understood that this case is being opposed by Eastern Cape MEC for Finance Mlungisi Mvoko.
Other underserved areas
The Democratic Alliance’s Malcolm Figg also raised concerns about EMS cover in other parts of the province. In the Blue Crane District, around Somerset East, only one ambulance is operational — even though the area requires at least three to serve its 40,000 residents.
“Every delay in transport raises the risk of death, worsens outcomes for critically ill patients, and endangers mothers in labour,” he said.
“The department must move swiftly to fill critical staffing vacancies in Emergency Medical Services, accompanied by a credible recruitment and retention plan that rewards skilled professionals for remaining in the public sector,” he said.
He said a petition for more ambulances in the district had already gained traction and now had more than 1,000 signatures.
According to records from the Eastern Cape Department of Health, the province requires a fleet of 650 ambulances, yet only 439 are available. Mechanical faults and lengthy repair times have left around 190 of these vehicles out of service.
“The Constitution guarantees the right to access healthcare services, including emergency treatment. Failing to meet this duty places the provincial government in breach of its legal obligations. Rural communities deserve the same level of care as those living near major hospitals in larger towns. Residents of Blue Crane Route cannot afford to wait months for help. Ensuring timely emergency medical care is a constitutional obligation,” Figg said.
In Graaff-Reinet, communities are actively fighting a decision to close the call centre in their town that services the larger Dr Beyers Naude District Municipality, including Jansenville and Klipplaat. DM