**Background:** The COVID-19 pandemic necessitated a rapid shift to telemedicine (TM) to minimize physical contact and infection risk. In South Asia, where healthcare access is often limited, TM emerged as a critical tool for managing both COVID-19 and chronic conditions. This systematic review aimed to evaluate the strengths, weaknesses, barriers, and limitations of TM in South Asia during the pandemic and beyond.
**Methods:** The review followed PRISMA guidelines and was registered on PROSPERO (CRD42023454835). Three databases (PubMed, Google Scholar, ScienceDirect) were searched using terms including 'Telemedicine', 'Teleconsultation', 'Telehealth', 'COVID-19', and South Asian countries. Inclusion criteria were real-life TM user experience studies from South Asia, excluding editorials, reviews, and physician perspectives. Data extraction covered study characteristics, advantages, concerns, and satisfaction levels. Quality assessment used the Joanna Briggs Institute (JBI) critical appraisal tools, categorizing studies as low (<50% criteria met), moderate (50-70%), or high (>70%) quality.
**Key Results:** Of 357 initially identified studies, 28 met inclusion criteria. Over 53% (n=15) were high-quality, 35.7% (n=10) moderate, and 10.7% (n=3) low quality. Nearly 75% (n=21) of studies were from India, with the remainder from Pakistan (n=3), Bangladesh (n=2), Sri Lanka (n=1), and Nepal (n=1). Most studies (n=21) were conducted in 2020. The most common health disciplines using TM were cancer, autoimmune diseases, and neurological disorders. Advantages reported included cost-effectiveness, time savings, and avoidance of travel. Concerns included connectivity issues, privacy, lack of physical examination, and difficulty for elderly patients. Satisfaction levels were high: among nine studies reporting satisfaction, eight reported >80% satisfaction, with one study reporting 98% satisfaction. Specific findings included: for autoimmune diseases, 78.5% of patients were effectively managed virtually; for dermatology, TM accurately diagnosed 93.45% of cases; for cancer, TM helped modify treatment plans for 19.5% of head and neck, 4% of gynecological, and 10.1% of breast cancer patients; for epilepsy in children, 96% satisfaction was reported; for type 2 diabetes, 82% satisfaction was noted; for otolaryngology, 71.5% of patients reported complete recovery; and for sexual and reproductive health, 74% of patients received medication without adverse outcomes.
**Clinical Implications:** Telemedicine proved to be a valuable, accessible, and satisfactory healthcare delivery model in South Asia during the COVID-19 pandemic, particularly for chronic disease management and follow-up care. However, barriers such as technical issues, privacy concerns, and the need for physical examination in certain conditions limit its universal application. The review underscores the need for region-specific TM guidelines, improved infrastructure, and training for both providers and patients to optimize TM use. While TM cannot replace in-person care for emergencies, surgeries, or complex diagnoses, it is highly beneficial for primary care, monitoring, and reducing healthcare access disparities, especially in resource-limited settings.