The province’s Gert Sibande District, a pilot site for the National Health Insurance scheme, has only 38 ambulances to serve almost a million residents, according to documents in Health-e News’ possession.

The district’s 149 000-person Msukaligwa Municipality centered on Ermelo has just three ambulances while Albert Luthuli Local Municipality around Carolina has one hospital-based ambulance.

“People are either giving birth on the street (or) sometimes in bakkies,” said Patrick Mdletshe, a field researcher for the public interest law organisation Section27. “Many people have died in these townships while waiting for the ambulance. ”

When Nurse Hlope’s water broke two months ago, her mother an ambulance to take her to Piet Retief Hospital 20 km from her rural village of Wolvenkop. The family posted the father of Hlope’s baby at the roadside to guide the ambulance to the family home.

But the ambulance arrived six hours later, by which time Nurse’s mother, Elizabeth Maseko, had delivered the baby.

“I have taught myself to deliver babies because it’s not often that ambulances make it on time in this area and many babies have died,” Maseko told Health-e News.

Hlope lost her first child due to illness two years ago.

[quote float=”right”]“I have taught myself to deliver babies because it’s not often that ambulances make it on time in this area and many babies have died”

When Mduduzi Khoza* suffered chest pains, he paid R200 to hire a car to take him to the local clinic in Amsterdam. There, he was told he would need to be rushed to Piet Retief Hospital.

When he realised that he was part of a queue of patients awaiting emergency transport to the hospital, he paid a friend R300 to take him via car.

He and other community members have written to the Department of Health to request that an ambulance be stationed at Amsterdam’s 24-hour clinic.

Christabel Mahlangu from Mbalenhle outside Secunda says that she often has not been able to reach anyone when she dials the local 10177 ambulance hotline.

“When you call the call centre, it just rings and (there’s) no response,” she tells Health-e News. “One minute you could be talking to the call centre agent and then they hang up on you.”

Mdletshe adds that many patients are not told when they can expect ambulances to arrive.

According the Department of Health’s latest annual report, 42 percent of posts at emergency communication centres are vacant. Among ambulance and emergency response personnel, about 14 percent of posts are unfilled and some staff have neither the appropriate qualifications or professional driving licenses.

Budget constraints have prevented staff appointments and the purchase of additional ambulances in the province. The health department has overspent massively and is currently under the administration of the provincial department of finance.

Thoko Madonko of the civil society Budgetary Expenditure Monitoring Forum says the Mpumalanga Department of Health is set to overspend its budget by R500-million and it has a R80 million overdraft.

Since 2011, the Treatment Action Campaign has written several letters to health officials at provincial and district levels to complain about the poor ambulance service.

“To this day, there is no plan coming out from the Mpumalanga Department of Health as to how they will solve the problem,” Mdletshe said. “It’s as if they don’t care about people’s lives.”

The Mpumalanga Department of Health acknowledged that the province was suffering from a shortage of ambulances that spokesperson Dumisani Malamule said was due to maintenance demands on an aging fleet. He added that 20 ambulances are currently being fitted with two-way radios before being deployed and the department will purchase an additional 30 before March 2014.

Malamule also told Health-e News that a shortage of funds prevented the department from contracting private ambulance companies. Similarly, staff and vehicle shortages prohibited the department from stationing ambulances at clinics and closer to rural communities.

*Name changed upon request

An edited version of this story was first published in The Star newspaper.

Read more on Mpumalanga’s health crisis as part of Health’e News’ “Deadly debt” series:

• Thousands face disability as orthopaedic services collapse
• NHI pilot district shows “signs of collapse”
• Drug-resistant TB patients lost in the system