Background: Clinical Practice Guideline (CPG) are an important tool to improve clinical outcome and to efficiently allocate resources. Development of context-specific recommendation is important for low and middle income countries. Previous research using AGREE-2 instrument showed that Peruvian CPG were of low quality. Actions from public health sector stakeholder have been implemented to improve the quality of CPG development process in Peru.

Objectives: To describe the efforts from the public healthcare sector in the last 3 years to improve CPG quality standards

Results: In the last three years, a number of actions were implemented: 1) The National Institute of Health of Peru (NIH) proposed a new 'Guideline to develop CPG' to the Ministry of Health (MoH) (approved in September 2015), which explicitly contained recommendation to adapt and develop de novo recommendations based on the GRADE framework; 2) Jointly the NIH and the MoH, developed a CPG of Dengue which contained a number of 'de novo' recommendations formulated with GRADE (published in February 2017); 3) the Institute of Health Technology Assessment and Research (IETSI) of the Social Security (EsSalud), worked in the adaptation of 5 CPG using the ADAPTE framework in 2016 (available: http://www.essalud.gob.pe/ietsi/guias_pract_clini.html); 4) The NIH is working on adapting CPG in maternal and mental health and IETSI in adapting CPG for cancer and cardiovascular disease, and, 5) training activities were offered by the MoH, NIH, and IETSI with collaboration from external partners as Panamerican Health Organization (PAHO) and the Institute of Health Technology in Health of Colombia (IETS).

Conclusions: In a short time significant steps to improve the methodological quality of CPG were put in place, however, this will need sustain compromise by stakeholders as well as to train a larger number human resources, to build collaboration between different health sector (private and public) and to incorporate cost-effectivenes evidence.