The global healthcare sector is a major source of emissions and waste; if the sector were a country, it would be the fifth largest emitter on the planet. Yet, despite being a huge contributor to the climate crisis, for too long, it has flown under the radar. Predictions are that unless it radically changes the way it operates, emissions from healthcare could triple between now and 2050.
ESG Mena spoke to Diaverum’s Global ESG Manager, Stephanie de Sury, to hear about how the Swedish-born, multinational healthcare organisation is working to address each letter in the ESG acronym while caring for those with Chronic Kidney Disease (CKD).
Stephanie, tell me about Diaverum and its healthcare mission.
Our mission is to provide life-enhancing renal care to patients with chronic kidney disease because everyone deserves a fulfilling life. We currently operate about 440 clinics in 24 countries across four continents, serving approximately 39,000 patients globally. Our focus is on delivering renal care tailored to the individual needs and choices of our patients.
We offer a comprehensive range of treatments, including preventive care, haemodialysis, peritoneal dialysis, home care, holiday dialysis and coordination of patients’ comorbidities. Our goal is to deliver superior medical outcomes and improve the well-being of our patients, exceeding the expectations of national healthcare systems.
We want to transform the industry through patient-centric digital innovations, delivering and broadening access to the highest quality of care. Central to our ambition is our proprietary, digitalised and standardised care delivery model, designed to ensure improved medical outcomes and to contribute towards further higher longevity and lower hospitalisation rates of our patients.
Can you tell me about the prevalence of chronic kidney disease globally and, more specifically, in the Mena?
Chronic Kidney Disease (CKD) is a significant global health issue, affecting approximately 10% of the world’s population. Its prevalence is increasing, particularly in low- and middle-income countries, primarily due to diseases such as diabetes and hypertension, which may, in turn, be linked to unhealthy lifestyles.
In 2019, in the Middle East and North Africa (MENA) region, new CKD cases have shown a substantial increase, with a 70% rise over the last three decades. Exact numbers for the MENA region can be hard to find due to disparities in healthcare infrastructure, reporting and access to care. However, existing data suggests that CKD is a significant health problem in the region.
Several risk factors contribute to the prevalence of CKD in the MENA region, including high rates of diabetes and hypertension, as well as lifestyle factors. Rapid urbanisation and lifestyle changes in the MENA region are also contributing to the increased prevalence of non-communicable diseases like CKD. Additionally, access to healthcare and resources for managing and preventing CKD can be limited in certain parts of the region, leading to higher rates of advanced disease and complications.
It’s also important to note that regional conflicts and large, displaced populations in the MENA region pose unique challenges to the delivery of healthcare, including care for chronic conditions like CKD.
Healthcare is becoming increasingly digitalised, can you tell me about the company’s ongoing digital transformation and how this is supporting more robust care delivery?
Our ongoing digital transformation is integral to our mission of providing life-enhancing renal care to patients with chronic kidney disease. We recognise the increasing importance of healthcare digitalisation and have made it a priority to leverage patient-centric digital innovations for the benefit of our patients. We envision a future where physical clinics and digital platforms work hand in hand to enhance renal care. To achieve this, we are developing and implementing a range of digital solutions and applications tailored to our patients’ needs. These solutions include AI prescriptive & predictive analytics, mobile apps, and other technologies that enable us to deliver efficient, personalised care that is tailored to each patient’s unique requirements. By harnessing the power of digital technology, we aim to improve treatment effectiveness, enhance operational efficiency, and drive positive medical outcomes on a global scale.
Our digital initiatives empower patients to actively participate in their own care and well-being, enabling them to make informed decisions and contribute to their treatment journey.
A key milestone in our digital transformation is the development of a unified digital platform that connects our clinics worldwide. This platform consolidates over 30 years of dialysis expertise, ensuring consistent and high-quality care for our patients, advanced support for our clinical teams, and cost-effective solutions for payers. We believe that digital technologies are reshaping the future of the healthcare industry, and we are committed to being at the forefront of this transformation.
What is the company doing to promote health literacy in the MENA?
At Diaverum, we view health literacy as a two-sided issue, and a responsibility we embrace keenly across all our regions. By empowering our patients to be aware of their condition, how to plan life around it, and to advocate for themselves in a healthcare setting, they, in turn, are able to access, assess and use information & services, becoming better able to engage in healthcare decisions and management. In each country, our dialysis nurses and other healthcare professionals devote time to helping our patients learn about kidney disease and building good and trusting relationships with them.
Through our websites, d.CARE patient app, leaflets, webinars, animations and one-to-one educational conversations, we work to ensure that our patients can obtain, understand and use the information they need to live well alongside their dialysis treatments. Some initiatives we have that are worldwide and cover our MENA-based patients as well, including our d.CARE patient app, which was created to enhance a two-way communication process between them and their healthcare teams; some of its ever-evolving features include logging current and historical data on blood pressure levels, heart rate and weight before & after dialysis. This means that patients can be involved in their treatment, giving them more agency around the process. We also invest continually in Patient Education material that is made available to all our worldwide locations for localisation/adaptation. This includes a recent animation campaign that encompassed a diverse range of topics concerning CKD, including dietary advice and mental well-being.
We’ve also hosted a number of educational webinars, with plans for more in the future; in short, Diaverum has a deep-held belief that health literacy is inextricable from our True care culture and one we’re dedicated to supporting. Many of our countries, such as Saudi Arabia, run initiatives that are bespoke to the needs and requirements of the local patient population. The latter, for example, runs a Patient Education Programme (PEP) that aims to support patients in developing self-care skills. Thinking about education more broadly, through d.ACADEMY, our digital platform for learning, we empower our employees and patients alike, providing them with clinical and medical information, knowledge and opportunities for personal development. d.ACADEMY in Saudi Arabia includes a certified training centre located in Riyadh, providing continuous education in practice, with accreditation from the Saudi Commission for Health Specialties (SCFHS).
Tell me about the importance of having a value-based healthcare model.
Value-based healthcare is of paramount importance as it seeks to optimise the relationship between patient outcomes and the cost of treatment, ultimately delivering value to both patients and payors in a highly efficient manner. Value is defined as patient-relevant outcomes over costs per patient to achieve these.
A value-based healthcare model encourages a holistic and integrated approach to care delivery, promoting coordination among healthcare providers, specialists, and other stakeholders involved in the management of CKD. In the case of chronic kidney disease (CKD) patients, the current models of care are often fragmented, with separate provisions for different aspects of the disease. This fragmentation not only hampers efficiency but also places a significant economic burden on healthcare systems.
Recognising this, Diaverum firmly believes that renal care can greatly benefit from transitioning to a value-based healthcare model that encompasses the entire care cycle for CKD patients, spanning from prevention to renal replacement therapies. Although dialysis is still largely under a fee-for-service model, there is an ongoing long-term trend towards value-based care, with Diaverum well-positioned for this transition.
You are a signatory of EPiHC; tell me about this and the importance of access to effective and affordable healthcare.
Becoming a signatory of EPiHC and committing to align to its principles was a natural and proud step for Diaverum. Private healthcare providers such as Diaverum have an important role and duty in advancing global access to affordable healthcare, something that we continuously take active steps to ensure. In voluntarily adopting EPiHC’s principles, Diaverum can be seen as making a tangible commitment and a promise to its stakeholders to operate as a responsible and ethical organisation.
In building this trust, we are, in turn, better positioned to deliver the possible care to the greatest number of patients, wherever they are in the world. Furthermore, as an EPiHC signatory, we are connected to a global network of like-minded organisations and initiatives that enables us to share our experiences, learn from other industry leaders, and collectively contribute to advancing global access to high-quality and affordable healthcare.
Tell me about your ESG strategy, activities, important areas of focus, and how your approach relates to the UN Sustainable Development Goals (SDGs).
As we accelerate and progress on our ESG journey, we have defined a roadmap for the next two years that focuses on:
- Aligning and further integrating the Sustainable Development Goals (United Nations 2030 Agenda) and Ethical Principles in Health Care (EPiHC) into our business development plans
- Reshaping our ESG reporting in order to be compliant with the Corporate Sustainability Reporting Directive (CSRD) according to the new European Sustainability Reporting Standards (ESRS), preparing to subject it to external and independent third-party verification
- Defining specific goals in each of our ESG framework pillars and improving the measurement of our impact on our key material topics
- clarifying our environmental strategy for the medium and long term
- Cementing ESG principles within our ongoing value propositions As a leading global provider of renal care services, our operations are inherently intertwined with the objectives outlined in the United Nations Sustainable Development Goals (SDGs). We thoroughly assess each of the UN SDGs and identify areas where our contributions can have the greatest impact. Through this analysis, we have identified four key SDGs where we can make a substantial difference: Quality education, Decent work and economic growth, Responsible consumption and production, and Good health and well-being.
Dialysis has a high waste generation – how are you tackling this?
Dialysis generates a substantial amount of waste on a daily basis, including PVC/silicone tubes, solution bags, dialysis tubing, medical sharps, and dialysers. At Diaverum, we are deeply committed to addressing this challenge and maximising opportunities for waste reduction, reuse, and recycling across all of our operations. To tackle the issue of waste generation, we have implemented various initiatives aimed at minimising our environmental impact. One example of our efforts is seen in Germany, where we collaborate with our local supplier to refill the concentrate containers used to produce dialysate fluid. This proactive measure significantly reduces the reliance on single-use containers, leading to substantial waste reduction.
In addition, we have implemented dry-concentrate production systems in countries like France and Spain. These systems minimise the need for disposable containers, contributing to waste reduction and promoting a more sustainable approach to dialysis. In North Macedonia, we have partnered with a specialised waste management company to convert our medical waste into regular waste, eliminating the need for burning. This collaboration allows us to implement a more sustainable approach to waste disposal while ensuring proper management of medical waste.
How are you promoting water conservation?
It is important to emphasise that haemodialysis requires significant amounts of water. Water is essential for dialysate preparation, machine and membrane cleaning, and reprocessing. Typically, 144 litres of water are prepared for a dialysis session, treated, sterilised, and heated to body temperature. However, the fact that in many renal care centres worldwide, 30%-50% of this water is discharged is a major issue.
To address this, we can implement initiatives to reduce water consumption. State-of-the-art reverse osmosis methods offer a solution, by minimising the amount of reject water produced during the water treatment process for haemodialysis. Moreover, the rejected water generated during reverse osmosis treatment can be repurposed within our clinics, effectively reducing water consumption and wastewater. Furthermore, it is difficult to take action if you do not measure your impact.
The implementation of smart water metres can provide real-time monitoring and analysis of water consumption, enabling us to identify abnormal usage patterns and take corrective actions promptly. Since 2020, for example, we have successfully utilised smart water metres in Saudi Arabia. In 2022, our efforts led to a remarkable consumption reduction of 0.15 m3 per treatment (from 0.77 to 0.62), resulting in savings of approximately 100-120,000 m3 of water (equivalent to around 25 Olympic swimming pools).
And, finally, can you tell me about your energy management and reduction strategies?
In 2022, we implemented a comprehensive data monitoring programme that allows us to monitor and analyse the energy consumption of all our clinics worldwide. By leveraging data and insights, we can identify opportunities for energy reduction and implement targeted strategies to enhance our energy efficiency. In countries where we have a significant presence, such as France, Saudi Arabia, Spain, and Portugal, we have already initiated several energy efficiency projects.
These initiatives encompass various measures such as upgrading to LED lighting, implementing smart metering systems, upgrading water heaters for improved efficiency, and conducting educational campaigns to promote energy-conscious behaviours among our clinic staff. These projects serve as best practices that we aim to replicate in other countries as part of our broader environmental strategy. By optimising our energy management practices, we can reduce our environmental impact, lower operating costs and contribute to a more sustainable future.