Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru

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TL;DR

This narrative review describes how Peru rapidly expanded telehealth services during the COVID-19 pandemic through regulatory changes (e.g., Legislative Decree No. 1490) and diverse initiatives in maternal health, nutrition, mental health, oncology, radiology, and ophthalmology. Key challenges include the digital divide, infrastructure gaps, and data security, but telehealth shows promise for strengthening health systems. The clinical significance lies in demonstrating that telehealth can maintain care continuity during crises and improve access in underserved areas.

Full summary

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**Background:** The COVID-19 pandemic accelerated the adoption of digital health services globally, including telehealth. In Latin America, telehealth adoption was low prior to the pandemic due to technological, educational, infrastructure, legal, and economic barriers. Peru, like other countries, modified its legal framework to promote telehealth during mandatory lockdowns. This narrative review aims to describe the regulatory changes and selected telehealth initiatives in Peru during the pandemic, and to discuss challenges for integrating telehealth into the health system.

**Methods:** The authors conducted a narrative review using keyword searches in Scopus, Web of Science, SciELO, and repositories (ALICIA, LA Referencia) for studies published from March 2020 to February 2023. Keywords included "telehealth", "telemedicine", "telediagnosis", "telemonitoring", "teleconsultation", "teleorientation", "tele-education", "teletraining", "telemanagement", "teletriage", "remote consultation", and "Peru". No language filters were applied, and snowballing was used. Two independent reviewers screened titles/abstracts and full texts. The initial search yielded 72 articles and 4 theses; after removing duplicates, 61 articles were screened, and 11 articles and 1 thesis (12 studies) were included.

**Key Results:** The review identified 12 telehealth initiatives across several specialties: - **Maternal Health:** At the Instituto Nacional Materno Perinatal (INMP), a telemonitoring program (May–August 2020) provided 2181 consultations for 616 pregnant women and 544 for puerperal women; 95% of providers agreed the program was adequate. A mixed telehealth model for prenatal care was easily adopted by professionals and users. - **Nutrition:** A nutrition-teleguidance service in three Lima healthcare centers identified lack of Internet access as a main barrier, while WhatsApp was a facilitator. A telenutrition service (Allikay Nutritional Center) showed no significant differences in weight, BMI, waist circumference, or relative fat mass compared to in-person care. A pre-experimental study in Tarapoto (n=78) found a decrease in BMI and glucose concentration after an 18-week telehealth program, but had limitations (no control group, non-randomized). - **Mental Health:** Hermilio Valdizán Hospital provided 57,398 virtual consultations (including 4411 mental-health teleorientations) between March and December 2020, plus 29 individual presentations and 15 academic conferences. - **Oncology:** The National Institute of Neoplastic Diseases (INEN) performed 16,456 teleconsultations from March 2020 to February 2021. Patient satisfaction scores were 4.6/5 for appointment scheduling, 4.58/5 for telemedicine service, and 4.33/5 for medicine distribution. - **Radiology:** Teleultrasound for lung imaging in five rural communities (213 tests) had 202 suitable for diagnosis, with 91% concordance between radiologists. Asynchronous telediagnosis for right-upper-quadrant abdominal ultrasound showed 95% agreement with standard care, with 93% sensitivity and 97% specificity for cholelithiasis. - **Ophthalmology:** In 16 Amazon villages, screening using a smartphone accessory with 3D printing identified 123 people with non-refractive visual impairment. Inter-rater agreement varied: poor for cataract (ICC 0.42) and corneal opacity (ICC 0.37), moderate for pterygium (ICC 0.67), and good for phthisis bulbi (ICC 0.76). - **Other Specialties:** In eight private healthcare centers, the most requested teleconsultation specialties were internal medicine (30.6%), endocrinology (12.7%), and pulmonology (6.2%). At Hospital III Regional Honorio Delgado (Arequipa), non-physician professionals had higher satisfaction (72.5%) than physicians (18.3%), and 77.6% of patients were satisfied. The maturity level of telehealth implementation (PAHO instrument) showed 32% null, 40.8% started, 25.2% advanced, and 2% ready.

**Clinical Implications:** Telehealth in Peru expanded rapidly during the pandemic, enabling continuity of care across multiple specialties. Key challenges include the digital divide (67% of Internet users access only via mobile phone), infrastructure gaps, data security (Law No. 29733), and the need for digital health literacy. Despite these barriers, telehealth demonstrates potential to strengthen health systems, especially in rural and underserved areas. The authors emphasize the need for interoperable health information systems, training programs, and stakeholder collaboration to sustain and scale these initiatives beyond the pandemic.