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Manitoba is not managing dialysis services as smoothly as it should, a new report by the province’s auditor general says.
Manitoba Auditor General Tyson Shtykalo’s report, released Thursday, was done to determine whether Manitoba Health and Shared Health are managing dialysis services efficiently as need increases.
The province’s rate of end-stage kidney disease was Canada’s highest from 2013 to 2021 and continues to rise, Shtykalo said.
The audit, which covered the period between April 2022 and March 2024, found Shared Health has no operational plan for dialysis services that “connects what the system is trying to achieve with how it’s going to get there.”
Shared Health’s organizational responsibilities for dialysis services are “unclear,” leading to uncertainty and contributing to inefficiencies, he 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,” Shtykalo wrote.
Shtykalo also found Manitoba’s funding model for dialysis services is not tied to patient outcomes or cost analysis and does not promote efficient service delivery.
Under health legislation, Shared Health is legally responsible for monitoring and evaluating how the province’s clinical and preventive services plan is being implemented.
“Although it has this responsibility, Shared Health has not done this,” Shtykalo wrote.
Shtykalo makes six recommendations in the report, with the first saying Shared Health should develop an operational plan that puts dialysis services in a “strategic direction for health care” that includes clear goals and required reporting.
In order to meet that recommendation, the report says Shared Health should collect, analyze and report the necessary data, implement a formal process to identify efficiencies, clearly define responsibilities and facilities for dialysis services, and use cost analyses of dialysis treatments to inform funding.
‘Period marked by system strain’
Health Minister Uzoma Asagwara says the audit examined “a period marked by system strain and years of fragmented planning under the previous [Progressive Conservative] government.”
The audit’s recommendations align with actions the current NDP government is already taking to improve kidney care, including expanded dialysis services in Norway House Cree Nation in the north, Asagwara said in a news release.
Since 2024, Manitoba has also established a provincial kidney health planning subcommittee, introduced standardized policy and procedure review processes, expanded education and training for kidney health staff and boosted support for home-based dialysis, the minister said.
Shared Health has developed a five-year strategic plan that aims to slow down the rising number of people who need dialysis, interim president Dr. Chris Christodoulou and vice-president Georgina Veldhorst said in a joint statement posted Thursday.
The plan’s three pillars seek to identify a patient’s kidney disease much earlier, manage resources wisely, and make treatment easier by expanding options for how and where people can receive dialysis, the statement said.
