The South African province with only one ambulance for every 20,000 people

The Free State has only 149 operational ambulances in its public healthcare system, which is half of the national planning norm.

This is according to DA Spokesperson for Health in the Free State Legislature, David Masoeu, who revealed that this is just over half of what is required for optimal operation.

“The DA is concerned about the chronic shortage of ambulances in the Free State, despite the Provincial Department of Health’s promise to improve the replacement of ambulances during the current financial year,” he said.

Masoeu highlighted that, according to the 2025/26 first quarter report presented to the committee, the Department of Health requires 291 ambulances and 2,328 EMS officials.

Instead, the province has only 149 operational ambulances and 1,523 EMS officials.

Given its population of just over 3 million, this results in an average of one ambulance for every 20,735 people and one EMS official for every 2,028 people.

“This, despite the departmental budget of over R14.6 billion, of which R995.8 million is allocated for Emergency Medical Services,” says Masoeu.

The province’s Department of Health received R14.1 billion for the 2025/26 financial year, which was increased by over R400 million in early December.

Of the R995.8 million allocated to emergency services, R974.6 million was allocated to emergency transport, and R21.2 million to planned patient transport, which refers to the non-emergency movement of patients.

A further breakdown of the emergency services budget shows that R975 million goes to current payments. This includes R751.7 million for employee compensation and R223.3 million for the acquisition of goods and services.

The province has allocated R19.7 million for the “payment of capital assets”, all of which has been assigned to “machinery and equipment.”

However, the budget does not mention acquiring more ambulances. Instead, it plans to hire more EMS officials.

“The department will work towards increasing the number of rostered ambulances to improve ambulance coverage and response times,” the budget reads.

“To achieve this, more skilled EMS officials will be appointed to increase the number of rostered ambulances to cover the population according to the norms and standards (1:10,000).”

Newsday has contacted the Free State Department of Health for comment about the planned acquisition of ambulances in the future.

A nationwide problem

According to a report by the Daily Maverick, South Africa’s public health system has a deficit of 2,221 ambulances as well as a significant skills gap in the paramedics pipeline.

Data provided by the National Department of Health shows that KwaZulu-Natal has the most severe shortage of vehicles to reach the optimal number of ambulances (one for every 10,000 people) at 715.

This is followed by the Western Cape, which requires 485 ambulances to reach this standard, and Mpumalanga, which requires 298.

At the national level, given South Africa’s population of roughly 62 million people, the country would need 6,228 ambulances. However, there are only 4,007.

As for EMS staff, the country currently has 16,445 personnel, or one for every 3,887 members of the public.

Of these, 80% are basic and intermediate life support personnel, 2% are emergency care technicians, approximately 3% are paramedics and emergency care practitioners (ECPs), and 15% work in management.

ECP paramedics are the only pre-hospital paramedics authorised to perform certain functions, such as intubation.