Manitoba dialysis services not being managed efficiently: auditor general

Manitoba’s auditor general has found a handful of issues with how the province is managing dialysis services.

A new report from Manitoba’s auditor general claims dialysis services are not being managed for efficiency in the province.

The report by Auditor General Tyson Shtykalo was released on Thursday.

The audit found several areas that it says the government needs to improve upon.

“There is no operational planning for dialysis services, which is needed to turn strategic goals into actions,” the audit explained.

It noted that responsibilities for dialysis services at the program level are unclear and have not been defined by Shared Health. This leads to uncertainty and contributes to inefficiencies in relaying services, Shtykalo writes.

The report concludes that the funding model for dialysis services “is not tied to outcomes or cost analysis, which does not encourage smarter use of resources.”

With Manitoba having the highest rate of end-stage kidney disease in Canada between 2013 and 2021, the auditor general says the number of people requiring dialysis will continue to rise—necessitating a streamlined approach to administration of services.

The audit says some of the confusion about the reporting structure for these services came from recent systemic changes. From 1998 until 2024, the Manitoba Renal Program coordinated kidney-related services. But, in 2022, planning and support services separated from delivery services, making Shared Health responsible for the planning component and facilities in charge of service delivery. Now, Shared Health and regional health authorities are in charge of administering dialysis to patients not receiving it at home, the audit explained.

The study also claims Shared Health is “not fulfilling its legal requirement to monitor and evaluate,” in accordance with the Health System Governance and Accountability Act.

Another issue highlighted was funding. The report says that it was unable to tie dollars spent on dialysis services directly to strategic objectives. An actual analysis of costs to assess the efficiency of it was also not available.

The report also includes six recommendations to improve how dialysis services are managed in Manitoba. It recommends Shared Health develop a clear operational plan that defines goals, monitors and evaluates how clinical and preventative services are implemented, gather and collect data to measure performance, and put into practice a formal process to identify efficiencies.

It also recommends defining the exact responsibilities of individuals and facilities utilizing dialysis services, and have the Department of Health, Seniors and Long-term Care, use cost analysis of dialysis treatments to advise how funding is used.

Shared Health and the Department of Health accepted all of the recommendations.

Meanwhile, the report states a provincial Kidney Health Clinical Plan is now in development and is expected to be completed in early 2026.

In a statement, Shared Health said it takes the findings of the report seriously.

It added it is carefully reviewing the report and plans to work with health authorities, government, staff, patients, and community to fully understand the findings and recommendations.

“Many of the issues identified reflected complex, system-wide challenges that required coordinated action across Manitoba’s health system,” the statement said.

“The reporting period also occurred during a time of significant system transition and pandemic response, underscoring the need for sustained, coordinated planning going forward.”

Shared Health noted it is committed to upholding standards of care, adding that work is currently underway in the areas of provincial planning, integration and performance monitoring.

The full statement can be found online.