Manitoba’s Auditor-General says the government is not effectively managing dialysis services, a critical treatment that is needed by a growing number of patients in the Prairie province.

Auditor-General Tyson Shtykalo, in an report published Thursday, said Manitoba is not funding or delivering the service in a clear, efficient or co-ordinated way. The audit examined dialysis services between April, 2022, and March, 2024.

One of the reasons the audit was undertaken is that Manitoba has the highest rate of end-stage kidney disease in Canada. Dialysis filters the blood to remove toxins, waste and excess fluids when the kidneys are not able to. It is the main treatment when a transplant is not available.

“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,” Mr. Shtykalo said in the 48-page report.

Opinion: An urgent prescription for our ailing Canadian health care system

He outlined three major concerns: There is no operational plan guiding the delivery of services in Manitoba, it is unclear who is responsible for dialysis services and the funding model is not tied to outcomes or cost analysis.

“A funding process that allows inefficiencies will always result in waste or not achieving the desired objectives,” wrote Mr. Shtykalo, who said strategic direction and funding decisions must be integrated to ensure efficient service delivery.

It is estimated that one in 10 Manitobans have some degree of kidney disease, but First Nations and people living in rural and remote communities are disproportionately affected, according to the report.

Provincial leaders across Canada are coming under fire for their handling of health care. Alberta’s Auditor-General last month concluded the province was using selective data to mask health care failings. In Manitoba, Premier Wab Kinew has promised to reform the health system – by reducing hospital wait times, for example – but critics say little has changed since he was elected in 2023.

Uzoma Asagwara, Manitoba’s deputy premier and minister of health, seniors and long-term care, said in a statement on Thursday that the audit highlights the previous government’s lack of planning.

“The OAG’s report examines a period marked by system strain and years of fragmented planning under the previous government. That was the reality we inherited,” Mx. Asagwara said. “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.”

Mr. Shtykalo noted in his audit that the problems he identified – lack of strategy, unclear roles and funding that does not drive efficiency – are not unique to dialysis services.

André Picard: The never-ending riddle of Canadian health spending

He pointed to recent reviews by MNP and Deloitte into governance, budgeting and fiscal management practices at Shared Health, Manitoba’s provincial health authority, and other health-services delivery organizations. These reviews “highlighted systemic weaknesses that threaten financial sustainability and service delivery,” Mr. Shtykalo said.

The Auditor-General provided six recommendations to improve dialysis services, all of which have been accepted or reviewed by Shared Health and the Manitoba government.

Included among the recommendations are that Manitoba clearly define the responsibilities of individuals and facilities for dialysis services; strengthen data collection, monitoring and evaluation of these services; and use cost analyses to inform funding.

The audit did not assess the clinical delivery of dialysis treatments, management of the provision of pediatric dialysis (or other treatments of kidney disease), or the transfer of Manitoba’s stand-alone renal program to Shared Health in 2022.