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



Reordenamiento de la oferta de servicios de salud para la atención de recién nacidos en Lima Metropolitana en las IPRESS del Ministerio de Salud, 2015-2019

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

Alfonso Gutiérrez Aguado, Seimer Escobedo Palza, José Manuel Luicho Sobrado, Miguel Angel Huamaní Contreras

Dear Editor

Neonatal maternal morbidity and mortality is a public health problem in Peru (1). 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 Governments (2).

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 in Table 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 complexity (3,4). 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 neonatal (5).

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.

Table 1. The attention of live births in health facilities Metropolitan Lima of the MINSA according to the level of care, 2015 - 2019.

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).

Author’s contributions: The authors participated in the genesis of the idea, project design, data collection and interpretation, analysis of results and preparation of the manuscript of this research work.
Funding: Self-financed
Declaration of conflicts of interest: The authors declare that they have no conflicts of interest.
Received: March 06, 2021
Accepted: June 14, 2021

Correspondence: Alfonso Gutiérrez Aguado
Address: Av. Los jazmines 114, urb. Las violetas, distrito de Independencia
Telephone: 988493448

Bibliographic 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:
    2. Ministerio de Economía y Finanzas del Perú. Programa presupuestal 0002, Salud Materno Neonatal. Programas Presupuestales con articulación territorial 2019. Disponible en:
    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:
    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.
    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.

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