Programme Director and Director General National Department of Health Ms Precious Motsoso

MEC for Health KZN Ms Nomagugu Simelane-Zulu

Head of Health in KwaZulu Natal Dr Sandile Tshabalala

From South African Military Health Service  Major-General  Dabula,

Director of EMS KZN Ms N Zungu

Principal KZN College of Emergency Care Ms B. Arends

Members of the Mahatma Gandhi Family

Invited Guests

Senior Members of the Provincial and National Department of Health

Emergency Medicine Practitioners

Colleagues

and Friends

I am very humbled to have this opportunity to pause and reflect on the lives of the men and women who perform heroic acts every day as they work in Emergency Medical Services.

Whether you are the one that answers that frantic phone-call, or the first one to lend a hand at an accident scene, you are usually the first touch-point of the health care system.

When you bring a patient into an emergency centre or a health care facility they have already been packaged and stabilized- but it is you who witness first hand the horrific scenes that make people come into contact with emergency services in the first instance.

Before we talk about the technical and legislative advancements in the field of Emergency Care, allow me to salute you all for your physical and mental fortitude that is so evident in the work that you do.

We have begun the work of overhauling the health care system in earnest as we prepare for the implementation of NHI.

Emergency medical service, being at the coalface of health care delivery, has not been left behind. EMS is most often the first point of contact into the health care system and it is therefore critical that the systems we put in place within EMS render effeciency in the pathway to care within NHI.

One of the main tenets of NHI, in its pursuit of Universal Health Coverage, is that of equitable access to Health Care. For many of our people, without EMS they would be unable to access health care at all as it serves as a mode of transportation between facility and home and not just an ambulatory medical service. So we appreciate the critical role EMS has already been playing in bringing health care closer to the people.

We know that EMS practitioners are being better empowered and capacitated to manage conditions right at the touchpoint and to be able to relay more and more information back to the referral centres before their expected time of arrival. The NHI embraces innovation in Emergency Medicine as well as technology that enhances the ability of healthc are practioners to save precious time and money, thus saving more lives.

Today, we launch the National Emergency Medical Services (EMS) Day, which will henceforth be 17 October annually. This is by no means an arbitary date as it carries historical significance: it was on this day in 1899 that The Natal Indian Ambulance Corps was established during the second Anglo-Boer war by Mohandas Karamchand Gandhi, thus marking the first formally documented ambulance service in South Africa.

But of course, we know that medical ambulation is as old as time itself. The sick have been carried on people’s and animals’ backs, on wheelbarrows, on sledges, on boats, on makeshift wooden planks, in sheets, in lagers and wagons- any manner possible that brings the patient to someone that can help.

While we are celebrating this day, we are also paying homage to the spirit of a gallant fighter for human rights in the person of Gandhi. We are today standing on his shoulders as we enjoy the fruits of freedom. It is thus fitting that in recognition of this larger than life person, we also launch this service that has been in the forefront of the response to the poor people in the informal settlements, in the farms, in the rural areas, in the factories, on the high ways and byways of our motherland and everywhere else, where our people find themselves in need of urgent medical attention.

 You are part of that legacy of love for humankind that was so strongly prevalent in Gandhi’s leadership. Given his firm belief in Ahimsa (non-violence), Gandhi focused on serving the injured during the second Anglo-Boer war, which was fought in Ladysmith, Newcastle, Vryheid areas of KwaZulu-Natal from October 1899 to February 1900.  One of the wagons used as an ambulance by Gandhi stills exists today in a wagon museum near Magaliesberg.

The National EMS Day was added to the National Department Of Health Awareness Calendar this year. The purpose of the National EMS Day is to raise awareness of the role of EMS within South Africa so we can create a platform for recognition and special achievements; and to honour all EMS personnel who often go beyond the call of duty.

It is my honour and pleasure to announce the Implementation of three digit emergency access number – 112

In October 2014, the National Health Council resolved to implement the three digit emergency access number as provided in the NHI White Paper and World Health Assembly resolution which clearly states the necessity of the three digit emergency number - 112.

Section 76 of Electronic Communications Act of 2005 makes provision for the establishment of public emergency communications services in South Africa known as “112”. 

The operations of the 112 numbe act as the filter for emergency organizations, thereby screening calls and routing only emergency related calls to specific emergency organizations being needed i.e. Police, EMS and Fire.

The 10177 emergency number that has been used by EMS will be phased out and we continue to refine the implementation of this service across telecommunications networks. The modernising of Telkom's landline network allowed for the implementation of the Automated Voice Response (AVR) system that prompts and directs you to the correct emergency response service. 112 is easier to remember that 10177, even for children, and so we are very excited to be able to offer a far more convenient service that ensures everyone can make that all important call for help. We appeal to the public to give as much information as possible to a responder when calling 112, including your telephone number, address of patient and a brief description of what is wrong with the patient. This information allows EMS us to call you back if necessary, find the patient quickly and send the most appropriate care to the patient.

There has been much work done to introduce the necessary Legislative and Policy Changes that will govern a more efficient emergency service.

The implementation of the Emergency Medical Services Regulations of 2017, promulgated under the National Health Act of 2003, have come into effect. What it means is that all operators of emergency care services, which are already in existence, had until the end of May 2019 to submit applications to provincial Departments of Health so that their business operations can be assessed. This will enable those who comply to be granted a licence to render emergency care services in the respective Provinces.

The licence will permit the operator to work only within a specific health district, and will be valid for a year and reviewed annually.  Those whose licence applications are deemed unsuccessful, following the assessment, will be given reasons for this, then given an opportunity to rectify their shortcomings and resubmit their applications. We beg for the indulgence of the potential applicants as we do everything to ensure that we give our people only the best, as we know the precious nature of life and indispensability thereof.

The primary aim of these regulations is to improve the quality of patient care and remove the sector of fly-by-night unscrupulous operators, whose conduct has, at times, placed patients’ lives at risk. Prior to these Regulations, there has not been a legislative provision to ensure that both public and private emergency care services are manned by registered and adequately trained staff, with proper and adequate equipment.  These regulations seek to address this and also ensure consistency and standardisation of operations in the sector, so that the service is the same, anywhere, everywhere and at any time – regardless of the operator involved.

Any operator who continues to provide emergency care services without a licence shall be guilty of an offence and may be liable, upon conviction, to a fine of up to R500,000.00 or a jail term of up to five years, or both.

Thankfully, most South African mass gatherings are peaceful without major incident, however, we have ensured that Regulations regarding Emergency Medical Care at Mass Gathering Events do exist. These regulations, which were implemented in mid 2017, serve to bring about minimum standards of emergency medical care provisions at mass gathering events. They specify the number and type of medical resources, number and qualification types of personnel and other infrastructural requirements when mass gathering events take place, in particular if the event involves high risk activities.

Continued training and eduction is crucial as we address and resolve one of the most critical pillars of the Health Compact: Human resources for Health. EMS education and training has been realigned to the Higher Education Qualification Sub-Framework Act of 2012. The short-course training system is in advanced stages of being phased out to make way for the implementation of a three-tiered EMS higher education qualification system.

The new system includes a one year Higher Certificate in Emergency Medical Care, a two-year Diploma in Emergency Medical Care and a four-year professional Bachelor’s Degree in Emergency Medical Care. These programs have already been phased in and we are now focussed on expansion of offering of the Higher Certificate and Diploma programs through our public sector Colleges of Emergency Care.

However, like the Nursing Colleges, our public sector EMS Colleges of Emergency Care will need to be declared as public Higher Education Colleges as stipulated in the Higher Education Amendment Act in order to offer these qualifications. We are in the process of engaging the relevant stakeholders in this regard. 

I would like to congratulate you all on your new corporate identity. I cannot emphasise enough how important it is in the medical emergency field to have an identity that is synonymous with care and respite. The mere visual of the men and women in green brings instant relief and comfort to anyone who sees you, even the doctors and nurses that recive you in their facilities.

Prior to this homogenous corporate identity, the decal of ambulances, the uniforms, the rank and the medical insignia were not standardized across all provinces.  The green used by government has been used as the basis for the branding of vehicles and the medical green is used for operational uniforms.  The 112 emergency number has replaced the outgoing 10177 emergency number displayed on all EMS vehicles.

We have repeatedly stressed how valuable and important Important EMS is to communities and quality health care delivery. But we have been deeply disturbed to witness EMS personnel being attacked by the very same community members they are serving. Anyone who attacks emergency workers declares war on the lives of our people. I am here today to tell the community that we cannot offord to jeopardise the lives of these critically needed skilled national treasures and therefore we will not tolerate this.

I stand proud that the EMS personnel continue to discharge their duties despite these threats, and I also dip my banner in honour of those who were attacked, injured or died in the line of duty.

I am very grateful that my colleague Deputy Minister of Health Dr Joe Paahla participated in the EMS Safety Symposium held late last year in Western Cape. This symposium was dedicated to address the atrocities directed at the EMS personnel. His presence there is an unequivocal commitment by the department to address this scourge and we will spare no effort nor courage until we eradicate this phenomenon. We are working with the Minister of Police to address this plight, and I am happy about the cooperation we continue to enjoy from SAPS, and their continued commitment to assist us in this regard.  

There are many interventions have been put in place through all levels of government to mitigate against these heinous crimes. There are four main interventional focus areas: Focus on Staff, Focus on Community, Focus of Technology and Focus on Management. Our work is not over and we cannot do this alone. We therefore call upon the communities to denounce these attacks and say together, enough is enough. The community must realize that EMS is an enabling arm of NHI as it aims to achieve Universal Health Coverage by taking health care to our people and then providing much needed transportation to hospitals. We are also at various stages of implementation of an EMS Safety Awareness course aimed at our most valued staff, a national EMS safety guideline and various technological advancements as mitigation strategies against these attacks.

More changes are envisaged for EMS. These will involve greater interaction with accredited private EMS providers, refinement, costing and national implementation of key services like Communication Centres, Planned Patient Transport Services, Inter-facility Transfer Services and Aeromedical Services.

Most importantly, the changes envisioned for EMS are to align with the provisions of NHI- this means shortened response times adherering to international norms and standards, kind and compassionate staff atttiutde in line with quality health care delivery, access to health care based on need and no-one being turned away or left behind when they need health care.

We have spoken about the workings emanating from the Health Compact and Quality Improvement Plan that are already taking shape to ensure that EMS is improving its service now and will be ripe for NHI when the time for implementation comes.

I would also like to take this opportunity to welcome the Health Sector Anti-Corruption forum because it will take care of the fraudulent activities that dent the efforts of honest hardworking men and women in the emrgency care sector. We know that this particular sector is vulnerable to fraudulent activities, such as vehicles being used outside of their prescribled mandate and government assets being bought and sold on the black market. We have a strong message ti send to perpetrators- the law will come down hard and fast on fraudsters- you will be made an example of. For those who are contemplatng such maleficence, we will catch you in the act, before you have a chance to siphon off government money and property. We say down with corruption and onwards into a proseprous future, driven by a corruption free NHI.

As a department, we are committing to making EMS a shining example of emergency care in the contect of Universal Health Coverage. Our President has already received recognition for the strides he had led us through: we were honoured to recieve the UHC Political Leadership Award in New York on our President’s behalf earlier a few weeks ago during the United Nations General Assembly festivities. We hope this serves as a beacon of hope to all South Africans that our health care sector is indeed moving in the right direction of delivering quality health care to all.

As you take your pledge today, be bound to its codes and uphold the highest virtue of integrity every day as you go about your demanding jobs. Let it serve as your true north, for it will guide you during your most trying times. The National Committee for EMS, a sub-committee of TechNHC, adopted the Nurses Pledge after some minor adjustments. The Nurses Pledge is comprehensive with a rich history and is also applicable to EMS. In my case, I took the Hippocratic oath, but it does not differ fundamentally from the oath you are taking today and so we are jointly bound to the highest order of excellence in patient care. I join you in solidarity and wish you all the best in your endeavours.

Thank You.