Dialysis services not properly managed, province’s auditor general reports

Manitoba is not managing dialysis services in a manner that promotes efficiency — one of the “weaknesses” systemic in the health-care system, a report released Thursday by the provincial auditor general said.

“Even though dialysis is a life-sustaining service, the province does not know if it is achieving the best results for patients and providing the best value for taxpayers,” auditor general Tyson Shtykalo said in a news release.

Manitoba has the highest rate of end-stage kidney disease in Canada, and the number of patients requiring dialysis continues to rise, it said.

The province spent $118 million in 2023-24 on dialysis operations, the report said.

The audit, which covered the period between April 29, 2022 and March 31, 2024, looked specifically at whether dialysis services are being managed efficiently.

“We found that the province does not have a clear strategy for dialysis services,” Shtykalo said in the report. “There’s no operational plan that connects what the system is trying to achieve with how it’s going to get there,” he said.

“Roles and responsibilities are unclear, which leads to uncertainty and can contribute to inefficiencies. And the funding model is not tied to outcomes or cost analysis—which doesn’t encourage smarter use of resources.”

Health Minister Uzoma Asagwara said the report highlights the need for co-ordinated, provincewide oversight of dialysis services after the “strain and years of fragmented planning under the previous government.”

“That was the reality we inherited,” the minister said in a news release late Thursday. Asagwara and the NDP government came to power in October 2023 after defeating the Progressive Conservatives and promising to fix health care.

“Since forming government, we have moved quickly to put proper structures in place, expand access to dialysis closer to home and build a system that is safer, more co-ordinated and focused on patient outcomes.”

The Tories did not respond to a request for comment.

Since 2024, the province established a provincial kidney health planning subcommittee, implemented standardized policy and procedure review processes, expanded education and training for kidney health staff, and strengthened supports for home-based dialysis, Asagwara said in the news release.

“These efforts are focused on improving patient outcomes, clarifying accountability, and ensuring dialysis services are delivered as efficiently and equitably as possible.” The expansion of dialysis services in Norway House Cree Nation reflects the government’s commitment to addressing long-standing gaps in access to care, particularly in northern and Indigenous communities, Asagwara said.

The auditor general’s report includes six recommendations to improve how dialysis services are managed, and responses from the province on actions it is taking to address them.

It recommended that Shared Health develop an operational plan that aligns dialysis services to the strategic direction for health care that includes clear targets and required reporting. It called for the collecting, analyzing and reporting of data necessary to measure achievement as well as performance of the health authorities in providing dialysis services.

“Many of the report’s recommendations align with work already underway, including provincial kidney health planning, clearer roles and policies, expanded education and training for staff, and stronger supports for home-based dialysis,” Asagwara said in an email to the Free Press.

“We will review the report in full and continue working with Shared Health, regional health authorities, Kidney Health Manitoba, and community partners to further strengthen dialysis care for patients and families across Manitoba,” the minister said.

The auditor general said the problems identified in his report are not unique to dialysis.

“MNP and Deloitte recently reviewed the governance, budgeting and fiscal management practices at Shared Health and other health service delivery organizations,” Shtykalo said in the introduction to his report. “Their reviews highlighted systemic weaknesses that threaten financial sustainability and service delivery.”

Shared Health said it’s reviewing Shtykalo’s report in detail.

“Many of the issues identified reflected complex, system-wide challenges that required co-ordinated action across Manitoba’s health system,” interim president and CEO Dr. Chris Christodoulou said in a shared statement with Georgina Veldhorst, vice-president for quality, performance and strategy.

They said the reporting period occurred “during a time of significant system transition and pandemic response, underscoring the need for sustained, co-ordinated planning going forward.”

carol.sanders@freepress.mb.ca