Paramedics in South Africa are sounding the alarm over critical shortages of ambulances and staff, leading to unsafe working conditions and inadequate emergency care for communities.
In a recent Parliamentary response, Health Minister Aaron Motsoaledi acknowledged that staffing levels are insufficient to cater to the needs of a population exceeding 63 million, with the government promising to enhance staffing as resources permit. As of April 25, 2025, KwaZulu-Natal (KZN) alone boasts 480 ambulances, though 240 of these are currently non-operational. The Eastern Cape faces a similar predicament, with 418 ambulances but 125 out of commission.
He stated that nationally, the ambulance to population ratio is 1:10,000, and there were 14,000 operational EMS personnel as of February 28, 2025.
State paramedics from the Northern Cape and the Eastern Cape, who have requested anonymity, have raised alarming concerns over chronic ambulance shortages that are endangering lives.
A paramedic from the Northern Cape said certain towns do not have ambulances or even staff.
He mentioned that one town near the N1 highway has one dilapidated ambulance with suspension issues, and staff are forced to use it or face unpaid leave or being booked absent without leave. “I’m an animal lover, and I wouldn’t even allow my pet to travel in a vehicle like that.”
Unsafe working conditions
He stated that while they attempt to maintain the ambulances to standard, the lack of cleaning materials poses a significant issue. This is compounded by the fact that the ambulances run 24/7, with vehicles being passed from one shift to the next. “In 2006, we had more than 15 ambulances per shift, and now we are down to about six maximum, depending on breakages and servicing.”
According to the paramedic, in one town, two ambulances have to cover about 300,000 people. “One day, I transported 16 people in the back of my vehicle because I could not leave anyone behind. They were serious cases.”
He recalls having to stop at the side of the road and offload patients in order to deliver babies. “These people must get back into an ambulance where the amniotic fluids and stuff is all over the place, including blood, and management just can’t be bothered.”
“Cross-contamination is taking place more than 100% because there is no time to sanitise the ambulance between calls. I have to use a mop and water to clean up blood because there is no soap.”
A few years ago, he said he was assaulted after coming late for a call due to the shortage of ambulances because the person was dead on arrival. He noted that the public are up in arms over this matter. When the government launched 22 new ambulances recently, we did not receive any despite our challenges, he added.
Equipment and resource deficiencies
“Our vehicles are poorly equipped; all our equipment is busted…some of us have to buy our own things like blood pressure cuffs and stethoscopes, etc.”
He said staff sometimes lack essential soft equipment like drips and, besides broken equipment, ambulance roadworthiness is worrying due to issues like worn tyres, broken windows, and tail lights.
Another paramedic from the Eastern Cape said they have been fighting over ambulance and staff shortages since 2023. “We have to work double shifts, and you get eight people on a shift sharing one ambulance to cover three towns plus farm areas and taking transfers from our town to other towns as far as 200 km away.”
He stated that the communities they serve are suffering despite involving councillors and expressed concern about poor service delivery statistics in the Eastern Cape.
Public outcry and union responses
There is increasing anger from the public with a potential for rising medical claims and fatalities among emergency medical officers, he warned.
He added that due to a lack of available ambulances, paramedics are permitted to use patient transport vehicles, which poses a challenge. They concur that management is indifferent to EMS staff concerns.
Unions confirmed that the shortage of ambulances and emergency medical services (EMS) staff is a major issue across the country.
The South African Emergency Personnel’s Union (SAEPU) president Mpho Mpogeng stated that while all provinces are badly affected, Mpumalanga and the Northern Cape are experiencing the most significant challenges.
Mpogeng particularly called out Gauteng, suggesting that the province is taking advantage of the internship system. “The province is operating with 80% of internship programmes because there is a shortage of staff…People think that Gauteng has enough staff and is rendering proper service; that is not the truth. Gauteng has ambulances but no staff.”
Not only does this have a negative impact on paramedics, but on the community as well, he said.
“The community members are robbed of the service they deserve because people could wait for an ambulance for 3-4 hours, which results in more deaths in the community,” he said, highlighting that the stipulated response time is 5 minutes.
Chronic staff shortages
Public Servants Association spokesperson Claude Naiker said all the provinces are experiencing chronic staff shortages since the department decided to fill only what they called critical positions.
Naiker noted that although Eastern Cape bought 447 ambulances, only 260 are operational owing to staff shortages.
“Similarly, Western Cape is experiencing the same problem, where only 120 of the new ambulances are operational for the same reasons,” he said.
Naiker said KwaZulu-Natal and the North West are also among the provinces mostly affected, with lower numbers of ambulances available compared to the required ratio.
He further noted that Eastern Cape’s shortages are worsened by funding and poor roads.
Naiker stated that slow EMS response times to emergency calls are causing conflict with families and the community, who make claims of laziness and incompetence.
“This threatens their safety as they are ridiculed, insulted, and even attacked. Sadly, the situation leaves them demoralised and demotivated,” he said.
Impact on communities
The impact on the public is worse, he said. “In many instances, the communities are forced to hire private cars to take their loved ones to the hospital to get medical attention. In some instances, they lose their loved ones who might have survived had they received medical attention earlier.”
Commenting on the situation in the Eastern Cape, the Health and Other Services Personnel Trade Union of South Africa (Hospersa) stated that there is a chronic shortage of ambulances.
“Staff must rotate usage; for example, in the Sarah Baartman District, if one ambulance is transporting a patient to a hospital in Gqeberha (Nelson Mandela District), the remaining ambulance cannot serve the community and must remain on standby until the first returns.”
The union reports persistent claims of insufficient funding within the Department of Health, hindering the employer’s ability to implement effective solutions. Consequently, staff are consistently compelled to work monthly overtime.
“The impact on EMS personnel is severe. Members are working extremely long hours without adequate rest, and overtime payments are often delayed and are only processed after repeated complaints.”
Hospersa said the psychological toll on staff is also significant, as there is no psychosocial support available to help them cope with the stress and trauma of their work. T
he union said the current fleet of functional ambulances is in poor condition and does not meet the standards outlined in the Occupational Health and Safety Act.
Hospersa said substandard ambulances endanger patients and some EMS stations are unsafe for staff, who have been mugged on duty.
In addition, lack of resources forces paramedics in some locations to use personal cell phones for emergency calls.
Government response and oversight
Health Portfolio Committee chairperson in the KZN Legislature, Imran Keeka, said the concern around ambulances is not new, and the committee has made KZN’s emergency medical services a priority.
On a typical day, KwaZulu-Natal has fewer than 240 vehicles travelling on its roads, he said.
“I have had anecdotal reports where, for example, for the entire eThekwini district, there are days on which only 5 to 10 ambulances work. Some are used as glorified taxis for inter-facility transfers,” said Keeka.
Keeka described the ambulance fleet as “aged,” and the fact that they travel over hectic terrain results in frequent breakdowns.
Last year, Keeka asked KZN Health MEC Nomagugu Simelane how many Emergency Response Services vehicles were in for repairs in each district. In response, the MEC said in all 11 districts, a total of 310 had mechanical problems, and 18 were involved in accidents.
In addition, 134 planned patient transport vehicles had mechanical issues, while 15 were involved in accidents. eThekwini had 72 emergency vehicles with mechanical repairs, the highest out of all the districts.
Keeka also questioned whether any of these vehicles would be in for repairs longer than 60 days.
The MEC said reasons for delays in finalising repairs include back orders for unavailable parts, and some vehicles have severe accident damage that takes more time to repair. At the time of the response, KZN had 26 ambulances and 40 public transport vehicles that were in for repairs longer than 60 days.
In December, the Portfolio Committee conducted oversight visits to four provincial districts and visited six facilities in KZN.
The committee expressed concerns about the preparedness of the EMS after identifying equipment shortages, shortages of disposable items such as bandages, gloves, and splints, incubators as well as infection prevention control cleaning materials for vehicles among other shortages.
“There is a gross shortage of vehicles in the four districts visited; this is compounded by the long period it takes to repair and service vehicles,” said the committee.
Keeka stated that the primary reason for the failure to increase the EMS vehicle fleet to the required 1,280 in KwaZulu-Natal is insufficient departmental funding.
The Department of Health did not respond to several requests for comment.
