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.