South Africa’s medical emergency crisis

Nearly 30% of South Africa’s public Emergency Medical Services (EMS) personnel positions remain vacant.

This has a major impact on providing emergency healthcare in the public sector, with the national public EMS personnel to population ratio sitting at 1: 4,311.

This was revealed by Health Minister Dr Aaron Motsoaledi in a written Parliamentary response to Democratic Alliance (DA) MP Dr Karl Le Roux.

EMS personnel are frontline professionals like paramedics who provide immediate medical care in emergencies.

This includes stabilising patients, offering treatment like CPR, and transporting them safely to hospitals via ambulance or air. 

According to the Minister, the total number of EMS personnel in the public sector is 14,447, with 4,048 vacancies, indicating that roughly 28% of EMS positions are currently unfilled nationwide.

Provincial highlights:

• Gauteng has the highest number of EMS personnel (2,966) but also a very high number of vacancies (1,106), suggesting significant understaffing despite a large workforce.

• Limpopo shows a striking disparity: 1,639 personnel but 1,841 vacancies, indicating it is the most critically understaffed province.

• Eastern Cape and KwaZulu-Natal have moderate staffing gaps.

• Provinces like Mpumalanga and North West have relatively low vacancies compared to their workforce.

Overall, the data reflects a serious shortage of public EMS personnel, particularly in Limpopo and Gauteng, which could affect emergency response times and public health outcomes.

“This shortage is a major crisis in South Africa that has a major negative impact on not only our work, but the public,” longtime EMS paramedic Richard Moodie told Newsday.

“The population is growing rapidly, and EMS personnel just cannot keep up, leaving people needing emergency care vulnerable because we are already overstretched.”

Moodie used the example of a general stroke patient, who would need to be with a specialist within a maximum of three hours.

“What you see in reality is that EMS might arrive at the scene 10 hours later, given that there is a staff and ambulance shortage. That results in irreparable, if not deadly, damage to the patient because of this.”

The big ratio and ambulance problem

The vacancies have a measurable impact on the provincial EMS personnel-to-population ratio.

Based on 2024/25 population estimates, at a national level, the public EMS personnel-per-population ratio is 1: 4,311.

Provincially, this is made up of:

• Mpumalanga – 1: 6,314
• North West – 1: 6,060
• Gauteng – 1: 5,611
• KwaZulu-Natal – 1: 4,793
• Western Cape – 1: 4,480
• Limpopo – 1: 3,803
• Eastern Cape – 1: 3,306
• Northern Cape – 1: 2,253
• Free State – 1: 1,946

Motsoaledi said that an EMS personnel-per-population ratio has not been prescribed by the World Health Organisation or in South Africa.

However, “the National Committee on Emergency Medical Services has adopted a staff-to-ambulance ratio of 10 EMS personnel to 1 ambulance to ensure uninterrupted service coverage over 24 hours.”

Yet, the South African public healthcare system is also struggling with an ambulance shortage.

In September 2025, the Daily Maverick reported that the country’s public health system has a deficit of 2,221 ambulances, while a significant skills gap exists in the ranks of its paramedics.

“At one hospital, for example, we used to be working with around 15 ambulances for the area. Now we are lucky to have five,” said Moodie.

“EMS is not a luxury, it’s a lifeline,” said Carla Griffith, a senior associate and medical legal specialist at DSC Attorneys.

The bigger issue and Department response

Apart from crippling budget constraints, Moodie attributes some of the vacancies to the cancellation of short-course certificates for the EMS sector.

“Although the system was not perfect, now we just aren’t seeing enough new people coming into the system.”

South Africa officially ended the short-course certificate for paramedics, phasing out the Basic Ambulance Assistant and Critical Care Assistant short courses by February 2018.

The Ambulance Emergency Assistant stopped by January 2020, shifting to a professional, university-based, tiered system (like a Higher Certificate, Diploma, or Bachelor’s degree).

“On top of this, you are seeing people who have been in the system for decades unable to progress because they did short courses decades ago,” said Moodie.

“If they want to progress, they have to go back and study but that means that many of them have to re-do their schooling to get the marks to get in.”

“This, coupled with budget cuts, ever-increasing work burdens and more, is leading to many people leaving the system,” he added.

In response to queries from Newsday, Department of Health spokesperson Foster Mohale said that the shortage of EMS personnel, like other categories of health care workers, negatively affects service delivery in the sector.

This is by adding more burden to available human resources and increasing turnaround time, among other impacts.

“This means that even if we have more ambulances, we will need more staff to operate them to address the longer waiting times for ambulances to respond to emergency calls,” said Mohale.

“The Department, working with provinces, is doing everything possible, including mobilising financial resources towards health system strengthening in order to ensure service delivery is not compromised.”

“Hence, arrangements have been made in provinces to rope in private EMS to assist as part of service level agreements as part of interventions because we acknowledge current budgetary constraints,” added Mohale.