A recent labour dispute involving emergency medical service (EMS) workers in the Eastern Cape has once again placed the spotlight on the province's chronic EMS problems.
Spotlight and other publications have often in recent years reported on the province's ongoing ambulance shortages and patients at times having to resort 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 Department of Health confirms the ongoing shortage of ambulances and blames it on funding shortfalls and the poor state of provincial roads that are ridden with potholes.
Spokesperson for the department, Sizwe Kupelo, says the province's EMS service should have 650 ambulances, but currently it only has a fleet of 439. He says the province has 181 patient transport vehicles and 41 rescue vehicles.
"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," says Kupelo.
He says the province has 2 173 EMS crew members - of which 1 377 are Basic Ambulance Assistants, 730 are Intermediate Life Support workers, and 66 are qualified to offer Advanced Life Support services. The Sarah Baartman District has the highest number of Advanced Life Support Paramedics with 14, followed by the Buffalo City Metro with 13, and Nelson Mandela Bay with nine. The remaining districts have from three to eight advanced life support paramedics.
"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 the Amathole and King William's Town areas.
The workers had embarked on what Spotlight understands to be an unprotected strike from April 2022 to November 2022, among others alleging 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 last year, 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 are working in line with the disciplinary code and procedure."
Lulamile Sihunu, Max Mandlingozi Regional Secretary of Nehawu, confirms that the union has appealed the worker's 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.
Poor road conditions blamed
In her department's annual report to the province's legislature, Eastern Cape MEC for Health 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 (GFMS) 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 sixteen 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.
"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.
"Therefore, it would be beneficial to have our own in-house maintenance center 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 that all districts, not only rural ones, have challenges with the turnaround times for the maintenance and repair of vehicles.
"The vehicles are rented from the Department of Transport and the 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 shadow spokesperson for health in the province, in a statement 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," her statement reads.
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"The provincial health department is in crisis, and based on the latest Auditor General's 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," she says.
Residents sometimes pay for own transport to hospitals
Spotlight previously 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 of Xhora Mouth depend heavily on government ambulances to get them to Zithulele hospital, the nearest hospital which is about 39 km away. Failure of an ambulance to arrive in time means they have to pay anything between R400 and R700 for private transport for a one-way trip to the hospital.
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 only to those areas.
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.
