Dialysis until the last drop: Testing the resilience of private haemodialysis centres in Kwazulu-Natal during prolonged water interruptions (Case Study).

Abstract

Healthcare facilities play a pivotal role in supporting the community when they are at their most vulnerable. As the provision of healthcare is heavily reliant on consistent supply of electricity and water, the impact of municipal interruptions of these services, has societal impacts and causes which considerably affects the healthcare sector. The province of KwaZulu-Natal encountered drought and various water crises over the past decade resulting in water interruptions being reported frequently in some areas of the province. Chronic Haemodialysis is a lifesaving therapy for patients’ dependant on the dialysis treatment. The process is heavily dependent on high volumes of quality water that is used for the process. The purpose of this case study is to measure the resilience of Chronic Haemodialysis Centers in the presence of prolonged water outages. This will generally be defined as the impact of prolonged municipal water interruptions as determined in four scenarios of water outage duration. These durations are <12, 12 - 48 and 24 - 48 and >48 hours. A resilience survey was distributed to 12 National Renal Care owned and operated Chronic Haemodialysis units in the KwaZulu-Natal area which were sampled by purposive sampling method. The surveys were completed and analysed using descriptive and inferential statistics. The feedback from the study showed that between 2016 and 2017, the majority of water interruptions which were reported in 9 centres were less than 12 hours. As a result, it was difficult to demonstrate whether the haemodialysis units at various centres were resilient and vulnerable, as the impact of the water interruptions was not as high as expected. Most of the interruptions from each of the units recorded a total average of 6.7 hours. It was recommended that future studies be carried out in other parts of South Africa to test the resilience of other units operated by National Renal Care, other dialysis companies and that South African Public Hospitals providing dialysis are also included. It was also recommended that centres should begin to explore other alternative water sources in an effort to ensure efficient and consistent services to chronic kidney patients during water crisis periods. Therefore, most of these centres were encouraged to embark on water sustainability projects in order to minimise waste streams. This can be achieved by recycling appropriate parts of processed water back into processes which rely on water but do not require the use of potable drinking water for their applications. In addition, it was clearly recommended that the development of minimum standards which include minimum water availability must be developed by the Health Professions Council of South Africa (HPCSA) as this will help to promote resilience in haemodialysis units servicing the patients in South Africa.