South Africa is facing a severe shortage of intensive-care unit (ICU) beds in the public health sector, with five ICU beds per 100,000 people at best available.

At the same time, in certain provinces, the figure is closer to one bed per 100,000 people.

This is according to Professor Fathima Paruk, head of the Department of Critical Care Services and Emergency Medicine at the University of Pretoria’s (UP) Faculty of Health Sciences.

She highlighted these alarming statistics during her inaugural address, titled “Carpe Diem: Achieving efficient and fair allocation of critical care across South Africa”.

She said the shortage of ICU beds in the country is a complex challenge.

“Hospitals are going to need more and more ICU beds because patients are living longer. ICU can save lives, and when patients live longer, they have more co-morbidities, so they end up getting sick more often.”

Advances in medicine and a shift to outpatient and home-based care have reduced the need for long hospital stays.

Paradoxically, these dynamics have increased the demand for high-level, short-term critical care, Paruk explained.

“In the private sector, you can literally create an ICU bed. In the public sector, you have X number of beds and that’s it.”

Geographic disparities, she explained, further complicate access. “If you’re in Cape Town, you’re much better off than in Limpopo.”

But, Paruk said, the limited number of beds is just one part of the problem, as one cannot run an ICU bed without nurses and doctors who are trained in critical care.

“We are extremely short on them in both the public and private sectors. Across the country, only 25% of our ICU nurses are trained in critical care.”

During her address, Paruk also touched on the changes that Covid-19 had brought about, and said that while it caused a huge disruption in the healthcare sector and beyond, it also brought a lot of good, including opportunities.

She explained how she employed telemedicine support for Steve Biko Academic Hospital and UP during the pandemic.

She described how a robot, Stevie, enabled collaboration between UP’s Department of Critical Care Services and Emergency Medicine and the telemedicine hub at Charité University in Berlin, Germany.

Paruk pointed out that telemedicine can play a significant role in addressing gaps in critical care in South Africa and is one of the most promising solutions for extending access to critical care in the public and private sectors.

“With telemedicine, you can help stabilise patients, and you can even help with a procedure. We can ultimately enhance the level of care to our community.”

Looking ahead, Paruk is part of the steering committee for a new national ICU audit, led by the Critical Care Society of Southern Africa.

“The last audit was conducted about 15 years ago, and a great deal has changed since then. There was a lot of generosity during Covid-19, equipment was given, beds were created, and people were trained. We want to see how this has changed things for patients.”

The audit will collect data from all public and private hospitals regarding available resources, including information about the number of ICU beds, staffing levels, and equipment.

The goal is to inform future planning, particularly as the country moves toward implementing the National Health Insurance, and to lay the foundation for a live dashboard that can help monitor and manage ICU capacity in real time.

zelda.venter@inl.co.za

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