An ageing ambulance fleet in KwaZulu-Natal poses significant challenges for emergency medical services, with over half of the vehicles exceeding their replacement mileage.
Image: Doctor Ngcobo / Independent Newspapers
The emergency medical services (EMS) of the KwaZulu-Natal Department of Health are under significant operational pressure, according to the findings of the 2025 Health Functionality Monitoring Programme.
Health Portfolio Committee Chairperson Dr Imran Keeka tabled a report on Thursday detailing oversight of KZN’s EMS.
The province-wide assessment evaluated whether the EMS system was adequately equipped for residents. The committee visited 32 EMS bases, headquarters, and 11 communication centres.
“The findings of the oversight visits reveal that the EMS system is under significant operational pressure,” Keeka said.
“One of the most serious concerns identified by the committee is the ageing ambulance fleet. The province currently operates with approximately 487 ambulances, and more than half of these vehicles have exceeded replacement mileage. This has resulted in frequent mechanical breakdowns and reduced fleet availability, and thus compromises emergency medical capacity.
“The committee noted that the province operates significantly below the national norm of one ambulance per 10,000 population.”
Keeka said that human resource shortages also remain a major challenge.
“The EMS establishment currently has over 300 vacant posts, including shortages of advanced life support practitioners, operational supervisors, and shift leaders,” Keeka said.
He said infrastructure in several districts were deemed inadequate and many EMS bases still operated from deteriorating temporary park homes.
Keeka said the province’s emergency communication centre lacked a computer-aided dispatch system, relying instead on manual processes. This limits real-time coordination and delays dispatches, directly impacting emergency response times, which nationally should be within 30 minutes in urban areas and 60 minutes in rural areas.
He said that by the fourth quarter, approximately 56% of required ambulances were only operational. Repair delays ranged between three and six months, compounded by logistical challenges in servicing the vehicles from rural districts, have further reduced the complete availability.
Keeka said the committee made recommendations to strengthen EMS functionality. These are now part of a turnaround plan to be tabled at upcoming meetings.
“These include accelerating the replacement and expansion of the ambulance fleet, introducing a modern computer-aided dispatch system, which is a requirement in terms of the regulations, and prioritising the construction of purpose-built EMS bases."
He said the urgent filling of critical vacant posts, particularly specialised emergency care, strengthening planned patient transport services to reduce pressure on emergency vehicles and ambulances, ensuring adequate budget allocation to support fleet renewal, infrastructure development, and human resource capacity, were some the aspects that needed attention.
KZN MK Party MPL, Nompumelelo Gasa, said the national norm stated that 1,189 operational ambulances were needed, and that the conditions paramedics worked in were a disgrace.
“In Phongolo, paramedics work out of a single park home. There is no kitchen. Men and women share one toilet. There are no showers. In Msinga, the base is a literal prefab structure on the verge of collapse. In uMlazi, the EMS base used to be public toilets,” Gasa said.
EFF MPL Thobisile Nkosi said the Department of Health must prioritise people’s lives from its restricted budget to tackle the crisis.
Sizophila Mkhize, an ANCMPL, said a structured EMS turnaround strategy was being implemented, targeting fleet renewal, human resources, infrastructure, and operational efficiency.
Mkhize said it was commendable progress under difficult and very tight fiscal conditions, including budget limitations and rising demand for services.
“Yes, challenges do exist. Yes, improvements are required. But this department is functioning. It is involving.”
DA MPL Shontel de Boer said that of the 3,052 approved provincial EMS posts, 2,731 are filled, leaving 321 technical vacancies. Some abolished posts due to budget cuts were not registered as vacancies in the Persal system.
Supervisory capacity is a major concern, with 89 of 167 shift leader positions vacant, significantly hindering 24-hour operational oversight. Operational staff shortages in the province include 179 vacant intermediate life support posts, 132 basic life support posts, one emergency care systems post, three emergency care technician posts, and 42 emergency care practitioner posts.
She also said that the EMS fleet poses a serious operational risk. Of the province's 487 ambulances, 38 advanced life support response units, and 11 rescue units, 248 ambulances (over half the fleet) have exceeded the 250,000km lifespan specified in the vehicle replacement policy.
IFP's Ncamsile Nkwanyana said resources must be used efficiently, and transparent reporting of departmental spending, including regular audits, must ensure funds are directed to frontline services.