EDITORIAL

Effectiveness of public budget expenditure assigned to neonatal maternal health

Lupe Vargas Zafrá

Master in Public Health
Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú.

ABSTRACT

The implementation of the results budget is considered one of the pillars of the modernization of public management in Peru, aimed at articulating the allocation of budgetary resources in activities and products to obtain positive results in favor of the target population. The budgetary program to improve maternal and neonatal health in Peru is 0002 Maternal and Neonatal Health, which begins in 2008; It currently has 18 structured products in interventions for disease prevention, promotion, care and recovery of the health of women of childbearing age and their partner, adolescents, pregnant women, puerperal women and newborns. The largest budget, with 14% of the institutional opening budget (PIA) in the current year, corresponds to the product of Refocused Prenatal Care, followed by the Normal Birth Care product; On the contrary, the product with the lowest budgetary allocation is the one aimed at providing health services for Pregnancy Prevention in adolescents, with 1.7% of the budget allocated.

The implementation of the results budget is considered one of the pillars of the modernization of public management in Peru⁽¹⁾, aimed at articulating the allocation of budgetary resources in activities and products to obtain positive results in favor of the target population. This process involves the design of budget programs, based on scientific evidence that guide the best way to program and execute the budget through goods and services, in effective results that are subsequently measured through performance indicators.⁽²⁾

The budgetary program to improve maternal and neonatal health in Peru is 0002 Maternal and Neonatal Health, it starts in 2008 together with the 0001 Nutritional Articulated Program; It currently has 18 products structured in interventions for disease prevention, promotion, care and recovery of the health of women of childbearing age and their partner, adolescents, pregnant women, puerperal women and newborns.⁽³⁾

Of the total budget allocated to the budget programs of the Health Sector, 22.6% is oriented to the Neonatal Maternal Health ⁽⁴⁾ budget program, being the second with the highest budget allocation. Of the products considered in the programmatic functional structure, the highest budget, with 14% of the institutional opening budget (PIA) in this year, corresponds to the product of Refocused Prenatal Care, that is, to develop activities aimed at monitoring and evaluation integral of the pregnant woman and the fetus to achieve a healthy newborn and a mother in good health. The second largest budgeted product, with 13% of the budget, is that of Normal Delivery Care, that is, the care provided to the pregnant woman and the newborn during the process of vaginal delivery and that is performed in the establishments with obstetric functions Basic neonatals (FONB) and in health facilities level I-III, considered as strategic; This care includes vertical delivery with intercultural adaptation.

On the other hand, the products that have the lowest budget allocation are those aimed at providing health services for Pregnancy Prevention in adolescents, with 1.7% of the institutional opening budget and the product of the Population informed about sexual health, reproductive health and methods of family planning, with 1.8% of the budget allocated.

The evaluation of the efficiency and effectiveness of the interventions of the budgetary programs are measured through the performance indicators. The indicator that measures the specific result of the 0002 Maternal and Neonatal Health budget program is the maternal mortality ratio and the neonatal mortality rate. Both indicators have been declining in Peru, according to the Demographic and Family Health Survey, the maternal mortality ratio decreased by 49.7% from 185 to 93 maternal deaths per 100,000 live births in the period from 2000 to 2010; also, the neonatal mortality rate increased from 18 to 10 deaths per 1000 live births in the period 2000 to 2018. ⁽⁵⁾

On the contrary, pregnancy in adolescents in Peru, measured by the fertility rate in adolescents aged 15 to 19 years, remains high, has decreased from 61 to 53 births per 1000 adolescents in the period of the years 2011 to 2018. Comparing this indicator by region, it is evident that in the rural area pregnancy is much higher in adolescents than in the urban area, with a proportion of 109 in the rural area and 41 in the urban area, in 2018. ⁽⁵⁾

These evidences show that the result of the budgetary allocation to the Maternal and Neonatal Health program is effective, reflected in the improvement of the indicators of specific results; however, the budget allocation within the products of the programmatic functional structure must be equitable, to ensure that interventions in the rest of the target population other than pregnant women, are also equitable. Greater budget should be provided to interventions aimed at improving the health of adolescents, for this purpose, the current operational design should be reviewed, supporting with scientific evidence the interventions that best result in the health of the population in this age group, knowing the social value that implies its good development.

BIBLIOGRAPHIC REFERENCES

1. Gobierno del Perú. Política Nacional de Modernización de la Gestión Pública al 2021. Presidencia del Consejo de Ministros, Perú, 2013.  [ Link ]

2. Directiva N° 002-2016-EF/50.01 Directiva de los Programas Presupuestales en el Marco del Presupuesto por Resultados.

3. Anexo 2 “Contenidos Mínimos del Modelo Operacional” del programa presupuestal 0002 Salud Materno Neonatal.

4. Sistema Integrado de Gestión Administrativa. Ministerio de Economía y Finanzas; 2019. Fecha de Consulta: 28.09.2019.

5. Encuesta Demográfica y de Salud familiar (ENDES). Institutito Nacional de Estadística e Informática; Resultados 2018; Perú.  [ Link ]

Correspondence: Lupe Vargas Zafra (lupevargaszafra@hotmail.com)