Ambulance sirens used to signal hope for medical emergencies, but in Mzansi, they’re turning into a grim soundtrack of silence. Ambulances are overwhelmed, leaving people waiting in agony for care. The gap between what the public needs and the services provided, is widening. It’s not just a lack of resources, it’s a human cost – a race against time.
South Africa’s public services are at a tipping point, and the cracks are showing in the most heartbreaking ways.
Cape Town-based social activist Nontuthuzelo Chabeni from Graceland says the gap between waiting for an ambulance in some areas of Khayelitsha is the difference between life and death, especially for those who cannot afford private transportation.
“Some lives could have been saved, but due to the high-crime areas, ambulances often do not enter for security reasons.”
Social activist Nontuthuzelo Chabeni
Crime-zone areas
Drawing from her experiences in rural, urban, and suburban areas, she notes that ambulances are sometimes called but never arrive or arrive very late, with no apparent reason from the hospital.
“These chains of challenges make it very difficult for people to receive assistance on time.”
She further states that in some high-risk areas, ambulances are escorted by police vans. However, if the police are simultaneously working with the health sector at that time, this may result in a shortage of vans in the security sector.
Emergency services delays
Noloyiso Siqele from East London in the Eastern Cape, identifies several areas that need improvement in the health department, particularly regarding ambulance shortages, poor service, and frustrations between healthcare workers and communities.
Siqele says in remote areas, it’s common to hear stories or witness deaths that could have been prevented if there were enough ambulances available.
“Sometimes ambulances are dispatched on time, but due to poor infrastructure, they take longer to arrive, especially in rural areas with terrible roads.”
Noloyiso Siqele
Late responses to emergencies, she says, are particularly concerning, even in nearby locations. “Promoting community engagement can help reduce late responses and delays in emergency services,” Siqele suggests.
Especially for people living in remote areas where these challenges are prevalent, Siqele recommends that the department of health could partner with these communities to provide training in first aid. She believes that equipping people in remote areas with medical skills could potentially save lives.
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Yonela Botwe from Cofimvaba, Eastern Cape, knows the frustration of waiting for an ambulance all too well.
“In January 2023, I called for an ambulance from Cofimvaba Hospital. After waiting for three hours, they called and said they were stuck and couldn’t move. I had to hire a private car.”
Yonela Botwe
This situation is common in their villages, where ambulances often fail to show up, sometimes without any explanation due to road challenges, she adds. As a result, many people have lost hope in the ambulance service altogether.
Health department acknowledges issues
The national spokesperson of the health department, Foster Mohale, explains that emergency medical services (EMS) are provided 24 hours a day, 7 days a week, in all 52 health districts by approximately 3 000 ambulances operating from 483 EMS stations strategically located throughout South Africa, in both rural and urban settings.
He says, “Ambulances are allocated to EMS stations that are either stand-alone or co-located in hospitals, clinics, and other public facilities.”
Mohale tells Health for Mzansi that ambulances are further strategically assigned within the districts into municipal areas based on community needs, including population density, location of district health services, accessibility to public transport, and related socioeconomic factors, taking into consideration budget availability.
“These ambulances are dispatched from our emergency communication centres within the respective districts when requested by callers/patients via our toll-free emergency number – 112.”
Mohale further notes that, notwithstanding these measures, the department acknowledges service-related challenges, such as ambulance shortages and a high number of ambulance breakdowns exacerbated by long turnaround times by repair service providers, etc.
They are also cognisant of the variance in service, says Mohale especially in rural communities.
“The national department of health is acutely aware of the challenges faced by communities regarding access to ambulances.”
Health department spokesperson Foster Mohale
Mohale says this becomes acute in deep rural areas where the roads are difficult to navigate, often resulting in several ambulance vehicles breaking down and becoming out of service for repairs.
The department is addressing this challenge, he says, by improving the system for maintaining ambulances across all provinces.
“All complaints are managed directly by health facilities within provinces. In the case of a complaint, the public can submit a complaint through the respective provincial EMS complaints platform.”
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Measures to limit problems
Mohale says the following measures are in place to complement number of ambulances:
- In planning the EMS footprint, provinces consider rural settings, and the most marginalised citizens are taken into account.
- Public EMS in all provinces has service level agreements with private EMS providers for urgent calls and interfacility transfers.
- Prioritised recruitment of EMS personnel for rural districts.
- Use of vehicles with 4 x 4 capabilities are sourced in rural areas for ease of access in the tough terrain of the province. It must be noted that road infrastructure in rural areas is poor and distances to be travelled between health facilities and communities is longer which results in longer response times to emergencies.
- Air ambulance service is used to access some of the hard-to-reach rural settings for life-threatening cases.
- Implementation of planned patient transport to reduce usage of ambulances for patients needing transportation only between health facilities.
- EMS plays an integral role in the district health system, as is the case in any geographical area, therefore, works collaboratively with primary health services and district hospitals to ensure access to and continuity of healthcare.
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