Norma Técnica de Salud para la Adecuación de la Organización de los Servicios de Salud con Énfasis en el Primer Nivel de Atención de Salud frente a la Pandemia por COVID-19 en el Perú

Objectives

Reduce the health, social and economic effects of COVID-19 across Peru by adapting and integrating health-service organisation, particularly primary health care, while maintaining continuity of priority non-COVID-19 care. The framework applies an Integrated Health Networks model that emphasises first contact, continuity, comprehensive and longitudinal care for individuals, families and communities.[1][2][3]

Its strategic orientation combines epidemiological and health-risk management with rights-based, gender, intercultural and territorial perspectives. It seeks culturally appropriate care for Indigenous, Amazonian, Andean and Afro-Peruvian populations, and recognises the need to address the circumstances of socially vulnerable groups.[4][5][2][6]

• Strengthen primary-level services as the entry point for prevention, early diagnosis, treatment, rehabilitation, palliative care and coordination of integrated care.[7][8]
• Contain transmission through case detection, testing, contact tracing, isolation, clinical follow-up, epidemiological surveillance and community action.[9][10][11]
• Mitigate health and wider social impacts through physical distancing, hygiene, mask use, risk communication and protection of people at higher risk of complications.[12][13][14]
• Maintain priority interventions, including immunisation, maternity care, chronic-disease management, communicable-disease care, mental health, disability care and support for vulnerable populations.[15][16]
• Ensure safe, accessible and quality care by separating COVID-19 respiratory-infection and non-COVID-19 pathways, protecting health workers and adapting human, physical and technological resources.[17][18][19]
• Provide care for suspected or confirmed COVID-19 cases regardless of health-insurance affiliation, with detection, diagnosis and treatment described as free of charge within Peru’s universal health-insurance framework.[8][20]

Implementation

Implement a coordinated national response across Ministry of Health, regional and local authorities, Social Health Insurance, armed forces and police health services, insurers, and public, private and mixed providers. National, regional and metropolitan health authorities lead within their jurisdictions, while Integrated Health Networks organise complementary service capacity, territorial sectors and population accountability.[21][22][2]

Deliver differentiated care through fixed facilities, mobile outreach, home visits, temporary services and telehealth. Facilities establish separate COVID-19 and non-COVID-19 teams and circuits, using distinct access routes, circulation areas, consultation spaces, medicine-dispensing arrangements and staff facilities where infrastructure permits.[23][9][19][24]

Use service capacity and clinical severity to determine care location, ranging from home isolation and remote monitoring to temporary isolation centres, assisted transport, hospital referral and intensive care. Temporary COVID-19 and non-COVID-19 services may be established through multisectoral committees led by municipal representatives when routine local capacity is insufficient.[25][26][27][28]

• Organise territorial sectors using Integrated Health Networks, catchment areas, population size, service coverage, accessibility, density and administrative boundaries; map suspected and confirmed cases and higher-risk groups using GeoRIS or other geolocation tools.[24][29][30]
• Conduct digital, telephone, in-person or domiciliary triage; assess symptoms, vital signs, clinical severity and risk factors; arrange testing, treatment, isolation, referral or assisted transport as indicated.[31][25][32]
• Deploy COVID-19 teams, Rapid Response Teams and Clinical Follow-up Teams for case investigation, specimen collection, contact tracing, home assessment, testing, counselling and remote or in-person clinical monitoring.[4][33][34][35]
• Schedule remote follow-up for mild home-isolated cases every 12 hours and for contacts, asymptomatic cases and discharged patients every 24 hours over the specified 14-day follow-up periods; arrange home visits where contact cannot be established or warning signs arise.[36][37]
• Record triage, testing, clinical follow-up and epidemiological investigation in the Integrated COVID-19 Information System, SICOVID-19, including Forms F00, F100, F200, F300 and F300.1 as applicable; use interoperable georeferenced data to support local response.[6][38][34][35]
• Coordinate referral and counter-referral through REFCON, centralised bed management and emergency transport services, including the Mobile Emergency Care System and authorised public, private and mixed providers.[39][40][41]
• Engage municipalities, community organisations, local leaders, community health agents and civil society in culturally adapted communication, risk-group monitoring, suspected-case referral, isolation support and local mitigation measures.[42][43][44]
• Protect workers through risk-based personal protective equipment, staff rotation, occupational safety measures, telehealth assignments for older, pregnant or clinically vulnerable staff, training and temporary redistribution of personnel where necessary.[45][46][47]
• Maintain daily updated hospital-bed availability lists and operational information flows, although the supplied material does not specify a comprehensive indicator set, evaluation timetable or independent performance-accountability framework.[40][48]
• Finance patient transport and care through relevant health-financing institutions and insurance benefit plans; the material identifies resource coordination and financial sustainability needs but does not provide quantified budgets, costs or funding gaps.[49][3][20]

Monitoring & Evaluation

The guideline establishes an operational monitoring and surveillance system centred on the Integrated COVID-19 Information System (SICOVID-19), linked georeferenced tools, clinical follow-up, contact tracing and bed-management processes. It assigns supervisory responsibilities to national, regional, metropolitan, network and facility-level authorities, but the supplied material does not set out a consolidated indicator framework, quantified targets, evaluation timetable or independent audit mechanism.[50][9][8][51]

• Record differentiated digital, facility-based and home-based triage in SICOVID-19 Form 00, classifying people as suspected or not suspected cases and enabling georeferencing of suspected and confirmed cases through GeoRIS or other available tools.[38][31]
• Maintain the Unique Register of Suspected Cases through continuous updating, allowing primary-level facilities to access information for rapid response and clinical follow-up in their jurisdictions.[50]
• Register clinical follow-up in SICOVID-19 Form 300 and record emotional distress, mental disorders and psychosocial concerns in Form 300.1.[36][52]
• Record rapid-test information in Form 100 and epidemiological-investigation information in Form 200, with Rapid Response Teams responsible for testing, investigation, communication of results and escalation where warning signs are detected.[35]
• Use remote and domiciliary monitoring to assess symptoms, clinical progression and warning signs among mild cases, contacts, asymptomatic people and patients discharged from hospital.[9][37]
• Schedule remote follow-up every 12 hours for mild suspected or confirmed cases in home isolation, every 24 hours for direct contacts and asymptomatic cases for 14 days, and every 24 hours for discharged confirmed cases until 14 days after discharge.[36][37]
• Arrange an immediate home visit when remote contact cannot be established or warning signs are identified, and coordinate referral and assisted transport where clinical deterioration requires higher-level care.[34][37]
• Conduct epidemiological surveillance through case detection, active contact-finding, contact tracing, sampling, risk-group identification and follow-up by health establishments, Rapid Response Teams and Clinical Follow-up Teams.[9][53][11]
• Use GeoRIS to integrate primary and secondary interinstitutional information, mapping and scenario simulation in support of timely decisions by health managers and senior leaders.[5]
• Interoperate records across SICOVID-19, electronic clinical records, REFCON referral and counter-referral processes, laboratory reporting through Netlab, and national georeferenced and bed-management applications where available.[25][39][48][54]
• Update available-bed lists daily for second- and third-level establishments through regional authorities, health networks and Integrated Health Networks to support referral coordination.[40]
• Maintain regional, provincial or district registers of temporary isolation centres to support coordination of available rooms, and register temporary care and isolation facilities in RENIPRESS in accordance with applicable regulations.[26][55]
• Monitor community risks through trained local actors, including surveillance of people at higher risk, identification and referral of suspected cases, temperature screening and communication of risk factors to health personnel.[56][43]
• Assign the Ministry of Health responsibility for technical assistance, supervision and evaluation of implementation of the technical health standard, while Regional Health Directorates, Regional Health Management Offices and Lima Metropolitan Integrated Health Directorates supervise compliance within their jurisdictions.[51]
• Assign operational oversight of Rapid Response Teams and Clinical Follow-up Teams to health networks, regional health authorities or metropolitan health directorates, with coordination across public, private and mixed providers.[35][52]

The material specifies information recording, clinical oversight, continuous register updates, daily bed reporting and jurisdictional compliance supervision, but it does not specify standardised performance indicators, reporting frequencies beyond these operational requirements, evaluation methodologies, audit procedures or public accountability reports.[34][40][8][51]

Costing & Financing

The guideline identifies substantial resource requirements and several financing responsibilities, but provides no quantified budget, unit costs, allocations, funding-gap estimates, resource-mobilisation target or economic assumptions. Financing is framed principally through public resources, health-insurance coverage and the responsibilities of health authorities and local governments during the COVID-19 emergency.[49][3][20][48]

• Finance detection, diagnosis and treatment for people affected by COVID-19 free of charge through the Peruvian State, the Ministry of Health and other health-insurance fund administrators within the Universal Health Insurance framework.[20]
• Cover or reimburse services provided to insured patients according to their affiliation, including care delivered by a provider other than the patient’s usual provider.[8][20]
• Finance patient transport and care through the relevant health-financing institution in accordance with applicable benefit plans.[49]
• Provide human, technological and financial resources through local governments and/or health networks for the duration of the COVID-19 health emergency.[48]
• Provide human, technological and financial resources for CAT arrangements through Regional Governments, with Local Governments and/or health networks responsible for equivalent resources within their jurisdictions.[51]
• Coordinate and redistribute available human and technological resources across participating public, private and mixed providers according to territorial emergency needs.[42][57]
• Maintain supplies of medicines, consumables, medical equipment and personal protective equipment through health establishments, health networks, territorial health directorates and regional health authorities.[27][28]
• Support temporary care and isolation services with infrastructure, biomedical equipment, medicines, supplies, trained personnel, accommodation, food, transport, cleaning, sterilisation and waste-management capacity.[26][58][55]
• Address workforce shortages through recruitment, additional hours and complementary arrangements with public, private or mixed providers after optimising existing personnel.[46]
• Seek municipal resources for community surveillance, diagnosis, telemedicine and teleconsultation, while ensuring supplies of protective equipment according to occupational exposure risk.[14][19]

Although the guideline repeatedly requires financial sustainability, resource sharing and mobilisation of service inputs, it does not state how much funding is required, how funds are distributed between institutions, whether resources are additional to existing budgets, or whether implementation faces a quantified financing shortfall.[50][26][49][48]