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Ileana Chac¨®n used to have to wake up at 4 a.m. every month to book a medical appointment at the nearest Public Health Center. She lives in Pacora, a community that is almost two hours away from Panama City. Despite managing diabetes and high blood pressure, Ileana and her sister, Bartola Chac¨®n, consider themselves lucky to be benefiting from Telemedicine services.

Ileana and Bartola work in a small-town food stall and have participated in the Telemedicine program for nearly three years. For them, the program has changed their lives. "For me, it is excellent; I no longer have to wake up early and miss a day's work; for example, I work in a small-town restaurant, and if I'm absent, I don't get paid for the day's work," says Ileana.

Thanks to Telemedicine, Ileana and Bartola have now learned how to monitor their blood pressure and sugar levels daily, which they report during call appointments with their doctor. They now only need to visit the Health Center every six months for essential medical tests, including pap smears, mammograms, and others. The results of these tests are sent to their doctor, who reviews them before the appointment. Based on the test results, the physician provides medical recommendations, offers overall counseling, and prescribes medication for managing their specific conditions.

Chac¨®n sisters are being treated by Dr. Eustaquio Sol¨ªs, who works at the Telehealth Program Contact Center of the Ministry of Health (MINSA) in Panama City. For Dr. Sol¨ªs, Telemedicine is a valuable tool that contributes to improving the comprehensive care of patients. It reduces the number of visits to the Health Center, thus decongesting the centers and allowing them to focus on emergencies or more critical cases. Importantly, it empowers people to take care of their health and well-being more proactively, and better control their chronic conditions.

Dr. Lisa de Le¨®n, who works in the Telehealth Program Contact Center, believes that the program benefits patients who live alone and have no one to accompany them to medical appointments. "Previously, some patients had to wake up at 3:00 a.m. every month to attend appointments, wait in long lines, and spend money they didn't have to obtain their monthly prescriptions. Everything is now solved with a scheduled call appointment," says de Le¨®n. She also recognized that when the program began, it was challenging for patients and doctors who were not familiar with the system and technology. Gradually, these technical difficulties were overcome, and the program has grown since then, with each doctor in the Contact Center treating around 20 patients daily.

Telemedicine serves as a crucial tool in treating individuals with chronic conditions like arthritis, diabetes, and hypertension in Panama. While the program itself is not a recent introduction, a significant milestone occurred in 2021 when legislation was enacted to establish clear guidelines for the development of telehealth services, prompted by the urgency of the pandemic. This has resulted in numerous benefits, such as the alleviation of hospital congestion, remote patient monitoring, and provision of preventive diagnoses, among other services, all contributing to making healthcare universally accessible.

¡°The Telemedicine project was an essential strategy of the Ministry of Health to provide continuous care for patients with chronic diseases during the COVID-19 pandemic¡±, says Dr. Ivonne Villareal, National Director of Health Services Provision. Currently, the program operates in 12 of the 16 Panamanian health regions. Similarly, while the program is growing, Villareal also considers there were lessons learned during implementation that could be addressed to improve the service.

Eduardo Miranda Martinez, another Telemedicine patient, has also had a positive experience. Telemedicine has improved his quality of life by eliminating the need to wait in long lines, commute, and wake up early for an appointment. However, for him includes bidirectionality in the services could be also valuable; ¡°for example, if a patient cannot keep his appointment, there is no way to contact the doctor to reschedule.¡± Additionally, Eduardo believes the service could be more efficient by shortening the time between appointments, which are usually scheduled every three months. Patient¡¯s feedback  like those from Eduardo Miranda, offer valuable insights for scaling and improving the Telemedicine program in Panama.

Now, two years after the implementation of the Telemedicine program, more than 60,000 people with chronic diseases have been attended. The Program is expanding to provide other services, including mental health, and using new technologies to move from a phone to a video call.

The Program is also piloting ways of connecting patients and doctors at primary healthcare centers with specialists in hospitals, to provide closer access to more specialized services. For example, the Program intends to reach the Indigenous Comarcas, starting with a pilot project at the Jos¨¦ Domingo de Obald¨ªa Hospital in the province of Chiriqu¨ª, which serves many of the Ng?be-Bugl¨¦ indigenous population.

Å·ÃÀÈÕb´óƬ and the Japan International Cooperation Agency (JICA) have been crucial partners of the Panamanian Ministry of Health in strengthening Telemedicine services by financing the acquisition of technological equipment and building the capacity of the national coordinators and of the doctors who will be working in the Telemedicine program. They have also worked with other partners, including the Pan American Health Organization (PAHO) to ensure coordination and complementarity.

The power of telemedicine and, more broadly telehealth, and the use of digital technologies is an innovative complement to facilitate Panamanians' access to quality health services, promoting health universality, especially for those who are more vulnerable and need it most.