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Revista de la Facultad de Medicina Humana
versão impressa ISSN 1814-5469versão On-line ISSN 2308-0531
Rev. Fac. Med. Hum. vol.21 no.3 Lima jul./set. 2021
http://dx.doi.org/10.25176/rfmh.v21i3.3746
Letters
Reorganization of the offer of health services for the care of newborns in Metropolitan Lima in the IPRESS of the Ministry of Health, 2015-2019
1 Facultad de Medicina Humana, Universidad Ricardo Palma, Lima-Perú.
Dear Editor
Neonatal maternal morbidity and mortality is a public health problem in Peru1. The Ministry of Health (MINSA) has designed various interventions to address this problem, such as family planning, delivery care by a health professional, and refocused prenatal care; which are part of the Budgetary Program (PP) Maternal Neonatal Health that is executed in the health establishments of the country of the MINSA and the Regional Governments2.
This PP is structured in products and investment projects in Peru, having executed in 2008 S /. 360,955,726 and 2019 S /. 2,207,496,661. The investment projects aim to improve the resolution capacity of health facilities (EESS) with Neonatal Obstetric Functions (FON). It is worth mentioning that only in investment projects during 2008 S /. 478,979 and 2019 S /. 311,339,340 in our country.
In the EESS of the MINSA of Metropolitan Lima, there has been an important reorganization in the care of newborns between the years 2015 to 2019 linked to the development of investment projects aimed at the expansion or creation of new offers for obstetric and neonatal care. Thus, there are about 90,000 treatments that are carried out annually in the MINSA EESS network, evidencing a migration of the EESS of level III (national hospitals and Specialized Institutes) to the EESS of Level II and I, as shown inTable 1.
In this period, care in the EESS of level III has decreased from 70% (2015) to 58% (2019) of the annual total, which the rest of the EESS has covered, showing that in the EESS of level II they have increased from 17% to 22% and in the EESS of level I from 13% to 19% in the aforementioned period. Highlights the Hospital de Emergencias Villa El Salvador (HEVES) role, which, since 2017, is an important provider of health services in general and specifically in the care of newborns with more than 4 thousand annual care. In addition, I-4 EESS has also increased this type of attention.
This new scenario of care for newborns in Metropolitan Lima has meant that more complex hospital establishments and institutes reduce this care quantitatively and; therefore, they could concentrate their health services on the most severe cases by their category and level of complexity3,4. In the case of level I service centers, strengthening their resolution capacity by improving the availability and competencies of human resources and adequate infrastructure, medicines, and equipment are the main challenges to guarantee the quality of care maternal and neonatal5.
Finally, based on this information, it is evident that the presence of a new provision of services brings with it changes in access and the behavior patterns of demand in the entire network of health facilities. Therefore, it is necessary to carry out process evaluations and impact, origin-destination analysis and economic evaluations, and others to develop strategies to accompany this reorganization and establish public policies that guarantee the coverage, quality, and efficiency of health services.
Level of care and IPRESS | 2015 | 2016 | 2017 | 2018 | 2019 |
---|---|---|---|---|---|
III level | 61,759 | 60,372 | 55,179 | 54,201 | 51,441 |
Instituto Nacional Materno Perinatal | 21,709 | 21,984 | 19,433 | 18,168 | 16,941 |
HONADOMANI San Bartolomé | 6,919 | 6,708 | 6,203 | 5,437 | 4,762 |
Hospital Nacional Dos de Mayo | 2,895 | 2,667 | 2,548 | 3,730 | 4,046 |
Hospital Nacional Arzobispo Loayza | 4,120 | 3,924 | 3,019 | 2,597 | 2,541 |
Hospital Santa Rosa | 2,123 | 1,809 | 1,829 | 1,826 | 1,701 |
Hospital Nacional Hipólito Unanue | 6,177 | 5,887 | 5,643 | 5,586 | 5,656 |
Hospital Nacional Cayetano Heredia | 4,355 | 4,107 | 4,467 | 5,615 | 4,915 |
Hospital Nacional Sergio Bernales | 5,674 | 5,629 | 5,383 | 4,840 | 5,003 |
Hospital María Auxiliadora | 7,774 | 7,645 | 6,640 | 6,383 | 5,855 |
Hospital de Emergencias Casimiro Ulloa | 13 | 12 | 14 | 19 | 21 |
II Level | 15,285 | 15,615 | 18,962 | 20,406 | 19,522 |
Hospital de Emergencias Villa el Salvador | - | 8 | 2,550 | 4,060 | 4,416 |
Rest of IPRESS II Level | 15,285 | 15,607 | 16,412 | 16,346 | 15,106 |
I Level | 11,319 | 14,395 | 15,850 | 16,548 | 17,039 |
Total Lima Metropolitana | 88,363 | 90,382 | 89,991 | 91,155 | 88,002 |
Source: System Registration of Live Birth Certificate Online - MINSA andNational Registry of Identity and Civil Status (RENIEC).
REFERENCES
1. Ministerio de Salud del Perú, Centro Nacional de Epidemiología, Prevención y Control de Enfermedades. Boletín Epidemiológico del Perú SE 04-2021, Pág. 111. 2021. Disponible en: https://www.dge.gob.pe/epipublic/uploads/boletin/boletin_20214.pdf [ Links ]
2. Ministerio de Economía y Finanzas del Perú. Programa presupuestal 0002, Salud Materno Neonatal. Programas Presupuestales con articulación territorial 2019. Disponible en: https://www.mef.gob.pe/contenidos/presu_publ/ppr/prog_presupuestal/articulados/articulado_0002_2019.pdf [ Links ]
3. Curioso Walter H, Pardo Karim, Loayza Manuel. Transformando el sistema de información de nacimientos en el Perú. Rev. Perú. med. exp. salud publica [Internet]. 2013 Abr [citado 2021 Feb 25] ; 30( 2 ): 303-307. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-46342013000200023&lng=es. [ Links ]
4. Huicho L, Huayanay-Espinoza CA, Hernandez P, Niño de Guzman J, Rivera-Ch M. Enabling reproductive, maternal, neonatal and child health interventions: Time trends and driving factors of health expenditure in the successful story of Peru. PLoS One. 2018 Oct 31;13(10):e0206455. doi: 10.1371/journal.pone.0206455. PMID: 30379907; PMCID: PMC6209344. [ Links ]
5. Huicho L, Huayanay-Espinoza CA, Herrera-Perez E, Niño de Guzman J, Rivera-Ch M, Restrepo-Méndez MC, Barros AJ. Examining national and district-level trends in neonatal health in Peru through an equity lens: a success story driven by political will and societal advocacy. BMC Public Health. 2016 Sep 12;16 Suppl 2(Suppl 2):796. doi: 10.1186/s12889-016-3405-2. PMID: 27634453; PMCID: PMC5025833. [ Links ]
Received: March 06, 2021; Accepted: June 14, 2021