By Sihle Mavuso
The KwaZulu-Natal Department of Health has quietly advertised a tender to outsource emergency medical services (EMS) to private ambulance operators, a move that would see them provide free transport to patients without medical aid.
The department, led by MEC Nomagugu Simelane-Mngadi of the ANC, pushed ahead with the bid despite concerns that, although framed as a temporary six-month measure, it could serve as a backdoor to the privatisation of the service.
The concerns about the tender are contained in a letter dated 5 August 2025, which was written to Premier Thamsanqa Ntuli by Chris Maxon in his capacity as an activist of Rise Mzansi.
Maxon is also a senior employee in the department, occupying the position of chief director for licensing, and he is currently suspended after he blew the whistle on the matter.
“While the Department of Health staggers under a R3.2 billion deficit and faces R20 billion in contingent medico-legal liabilities, it has chosen to outsource a core public function – EMS – to private operators. This is a textbook case of neoliberal state capture, in direct violation of Section 27 of the Constitution, which affirms the right of every person to access emergency healthcare services and imposes a duty on the state to progressively realise that right within available resources,” Maxon complained to Ntuli.
Maxon said the World Health Organization (WHO) has repeatedly warned against the fragmentation of public health services, stating that privatization of critical services like EMS undermines health equity and weakens universal health coverage (UHC).
“Yet this is exactly where KwaZulu-Natal is headed: While the department buys R1.35 million per ambulance, thousands of trained health workers remain unemployed. While private EMS providers prepare to profit, hospitals operate without CEOs, clinical managers, or finance heads. While families wait hours for emergency response, lawsuits for negligence pile up – 1,678 active cases with a best-value liability of R5.9 billion,” Maxon further wrote in the letter to Ntuli.
The tender (Bid ZNB 9057-2025-H) was quietly advertised and closed on 13 March 2026.
The dire state of the EMS service in the province was laid bare during a debate in the KwaZulu-Natal legislature on Thursday (yesterday) after MPLs visited EMS sites across the province to inspect them.
An MPL from the MK Party, Dr Mphikeleli Mthethwa, a former employee in state hospitals described the state of the EMS as “a disaster” and warned that roping the private sector is not going to work
“It is not implementable and as a result, nowhere in the world this (working with the private sector to bring ambulances) is functional,” Mthethwa said, adding that nothing is being done to address the shortage of ambulances.
During the debate, Shontel de Boer, MPL, the DA’s alternate spokesperson on health matters in the legislature said the current reality is that as the demand for EMS services increases, resources available to provide these services are not keeping pace.
“Key challenges affecting EMS in the province include infrastructure, human resources, fleet management, communication systems, increasing service demand and financial constraints,” de Boer said.
“The EMS fleet situation presents one of the most serious operational risks. KZN currently has 487 ambulances, 38 advanced life support response units, and 11 rescue units. However, 248 ambulances – more than half the fleet – have exceeded their useful lifespan of 250 000 kilometres, as stipulated in the Vehicle Replacement Policy. These vehicles remain in service because there are insufficient funds to replace them.”
Neither the provincial department nor the Office of the Premier in the province commented on the issue of the contentious tender despite being given three days to do so
INSIDE POLITICS