The Role of Virtual Hospitals in Limited-Resource Settings: A Scoping Review

The emergence of virtual hospitals, digitally coordinated healthcare systems offering remote consultations, diagnostics, monitoring, and specialist care, has introduced transformative opportunities in global health. These models have proven effective in high-income countries for addressing issues such as hospital congestion and chronic disease management. However, their potential in limited-resource settings, where healthcare systems are often constrained by poor infrastructure, workforce shortages, and geographical barriers, remains underexplored. Virtual hospitals could bridge critical access gaps in such contexts, particularly for underserved rural and peri-urban populations, if appropriately designed and supported. This scoping review aimed to systematically map the implementation models, digital technologies, governance and financing structures, and reported outcomes of virtual hospital systems operating in limited-resource settings. Additionally, the review sought to analyse the extent to which these models align with national digital health strategies, global policy frameworks, and Sustainable Development Goal 3 on universal health coverage. A comprehensive literature search was conducted using PubMed, Scopus, Google Scholar, and grey literature sources such as the WHO Digital Health Repository, national health ministry websites, and organizational reports. Studies published in English between January 2015 and May 2025 were included. The inclusion criteria focused on studies that described or evaluated virtual hospital models implemented in low- and middle-income countries, particularly those addressing healthcare access, service delivery, digital infrastructure, or health policy alignment. Data were extracted using a standardized charting tool and thematically analysed. Thematic synthesis revealed three dominant models of virtual hospital implementation: centralized hub and spoke systems, decentralized community-linked systems, and hybrid public-private partnerships. Technologies employed included mobile health applications, wearable diagnostic tools, AI-driven triage systems, cloud-based electronic health records, and remote teleconsultation platforms. Governance structures ranged from government-led models to those managed by NGOs and private tech companies, with financing derived from national health budgets, donor support, and emerging health fintech solutions. Service delivery outcomes included improved access to care in remote areas, enhanced follow-up and adherence in chronic disease management, reduced patient travel time and costs, and increased efficiency in referral coordination. Most models demonstrated alignment with national health strategies and global digital health priorities, although gaps in infrastructure, policy enforcement, and interoperability were common. Virtual hospitals hold considerable promise in reconfiguring healthcare delivery in limited-resource settings. Their scalability and impact depend on supportive policies, digital infrastructure investment, integration into national health systems, and community engagement. The Kenya case study illustrates how virtual care can be locally adapted to improve chronic disease management and mental health services through a tiered digital referral network. However, significant challenges persist, including limited digital literacy, unreliable internet and power supply, inconsistent policy regulation, and fragmented health information systems. Future research should prioritize the evaluation of long-term health and economic outcomes, patient and provider experiences, and strategies for equitable scale-up across diverse contexts. Tailored implementation frameworks and stronger cross-sector partnerships are essential to fully harness the potential of virtual hospitals in advancing universal health coverage in LMICs.