Building Community Capacity for Social Prescribing in Viet Nam: Funding, Workforce and Sustainable Partnerships

Building Community Capacity for Social Prescribing in Viet Nam: Funding, Workforce and Sustainable Partnerships

Category: Viet Nam Context

A social prescribing pathway can only be as useful as the community support available at the other end of it. A healthcare organization may identify a social need, a navigator may understand what matters to the person, and the referral process may work exactly as intended. But if the community resource is full, underfunded, difficult to reach, dependent on one exhausted volunteer or no longer operating, the connection still fails.

This is why community capacity is not a secondary implementation issue. It is part of what makes the pathway work.

For Viet Nam, that point deserves particular attention. Formal social prescribing remains limited, while community support already exists through a diverse mix of public services, social-work functions, associations, community groups, social and charitable funds, private providers, local initiatives, volunteer networks and informal relationships. The opportunity is not to replace this ecosystem with a new “social prescribing sector.” It is to understand what capacity already exists, where the gaps are, and how healthcare, social support and community resources could work together without simply shifting unmet demand from one part of the system to another.

A referral network is not the same as community capacity

It is relatively easy to build a directory. It is much harder to build and maintain a community ecosystem capable of receiving people reliably.

A service may exist but have only a few available places. An exercise group may operate on limited days. A community initiative may depend on one staff member or several volunteers. A useful program may be affordable for some people but inaccessible to others because of transportation, fees, disability access or language. Another organization may provide excellent support but have no practical way to receive referrals from healthcare or communicate when its capacity changes.

Community capacity therefore means more than the number of resources on a list. It includes availability, accessibility, workforce, competence, continuity, funding, relationships, information flow and the ability to respond appropriately when a person's needs exceed the service's scope.

A global scoping review published in July 2026 synthesized 115 empirical studies across 16 countries. It found that implementation was supported by clear referral pathways, defined roles, regular cross-sector communication, workforce support and sufficient community capacity. Persistent barriers included fragmented coordination, unclear roles, short-term or siloed funding, limited community-sector capacity and workforce instability. The broader lesson is that social prescribing operates through relationships, community capacity and local implementation conditions, not through referral mechanisms alone.

The practical implication is simple: investing only in the referral side can create a system that becomes better at identifying needs without becoming better at meeting them.

Funding needs to support the receiving side, not only referrals

International social-prescribing discussions often focus on clinicians and link workers. Those roles matter, but the organization receiving the person also performs real work. Someone has to respond to enquiries, explain what the activity offers, determine whether participation is appropriate, coordinate staff or volunteers, maintain facilities, manage relevant information, respond to difficulties and sometimes communicate back to the referring service.

None of that work is automatically free.

The international evidence repeatedly points to the importance of community-sector capacity and stable resources. Short-term funding, unstable provision and workforce pressures can weaken the community side of a pathway even when referral processes are functioning well.

Although not a social-prescribing study specifically, a 2026 evaluation of a collaboration fund involving voluntary and community organizations in Luton, England, provides a useful illustration. Collaborative working supported resource sharing, co-designed services, community trust and engagement, while financial constraints threatened sustainability. Participants emphasized continued investment, stronger networks and strategic support.

A 2026 case study of nature-based social prescribing in Lancashire and South Cumbria makes the funding issue more directly. It highlights the difficulty of sustaining the community organizations expected to provide activities after people are referred.

These experiences come from the United Kingdom and should not be treated as ready-made models for Viet Nam. But the underlying question is highly transferable:

If healthcare becomes better at referring people, who pays for the community capacity needed to receive them?

Pilot funding and sustainable funding are also different. A pilot may have a fixed budget, an innovation narrative and a short implementation period. Sustainable community-connected care requires recurring resources: staff time, volunteer coordination, facilities, communication, supervision, information systems and the less visible work required to maintain relationships.

Evidence from the Western Pacific shows that there is no single funding model for social prescribing and related community interventions. Government, mixed, charitable, nongovernmental and private funding arrangements have all been used. That diversity is another reason Viet Nam should not begin by assuming that one financing mechanism will fit every pathway.

A hospital-based pilot might fund navigation while working with independently funded community partners. Another initiative might combine public, philanthropic, community or private resources. Some activities may appropriately charge modest fees, while others need to remain free or subsidized for the populations they serve.

The key principle is not that healthcare must pay for every community activity. It is that funding assumptions need to be explicit and realistic.

If an organization is expected to receive increasing numbers of referrals, the pathway needs to understand what additional work this creates, who will resource it, and what happens when capacity is reached.

Funding should also recognize the work behind the visible activity. A class, support session or home visit is easy to count. Less visible are the hours spent maintaining directories, attending coordination meetings, communicating with navigators, training staff, monitoring quality, managing incidents, collecting data and updating referral arrangements.

Smaller community groups may have strong trust and relationships within their communities but limited administrative capacity. Requiring every small community resource to operate like a healthcare provider could exclude exactly the groups that are most locally connected.

The aim should therefore be enough structure for a reliable and safe partnership without unnecessarily medicalizing or bureaucratizing community life.

Workforce capacity includes paid staff and volunteers

The workforce supporting social prescribing is broader than the person who makes a referral or the navigator who helps make the connection. Depending on the pathway, it may include healthcare professionals, professional social workers, community health personnel, community-organization staff, activity leaders, peer supporters, volunteers and others who maintain local services and relationships.

Workforce conditions matter. High caseloads, turnover, unclear responsibilities and inadequate support can disrupt continuity. Clear boundaries, appropriate preparation, supervision and stable working relationships across sectors make implementation more sustainable.

This becomes particularly important when people have complex needs. A community worker should not gradually become responsible for clinical assessment simply because participants trust them. A volunteer should not be expected to deal alone with serious safety or protection concerns. A navigator should not become an informal case manager for unlimited needs because there is nowhere else to turn.

Workforce planning should therefore begin with functions and boundaries rather than job titles.

Who identifies the need? Who explores what matters to the person? Who understands available community resources? Who helps overcome access barriers? Who follows up when appropriate? Who manages clinical risk? When is professional social work needed? Who supervises the navigator? Who does the community organization contact when a situation moves beyond its role?

When these questions remain unclear, pressure tends to accumulate on whoever is easiest to reach.

Volunteers also require realistic expectations. Viet Nam has strong traditions of mutual assistance, community participation and voluntary contribution, and these are important assets. But community strength should not be confused with unlimited unpaid capacity.

Volunteers need recruitment, orientation, coordination and support. Their time is finite. Some roles may carry emotional demands or expose people to situations beyond their preparation. A community initiative dependent on a handful of committed individuals may appear stable until those individuals leave.

A sustainable model should therefore distinguish between functions that can reasonably be supported by volunteers and those that require paid, trained or professionally accountable staff.

Community strength does not mean unlimited unpaid labor.

Build from existing community assets, but understand the gaps

Viet Nam should not approach social prescribing as if community infrastructure needs to be created from nothing.

One useful example is the network of Intergenerational Self-Help Clubs. Decision No. 1648/QĐ-TTg, issued by the Prime Minister on 1 August 2025, approved expansion of the model through 2035. The project aims to establish at least 12,000 new clubs by 2035, while maintaining the quality of existing clubs and strengthening implementation and management capacity.

These are voluntary, community-based clubs that support different forms of mutual assistance, participation and healthy ageing.

They are not social-prescribing services, and they should not be relabeled as such.

Their significance is different. They demonstrate that Viet Nam already has organized community assets, local leadership and forms of mutual support with which future community-connected care may sometimes be able to work. The same principle can apply to associations, community activities, rehabilitation resources, social-work services, peer-support initiatives, cultural groups, private providers and informal local networks.

A future social-prescribing initiative should therefore begin with asset mapping rather than institution building.

The first question is not “What new social-prescribing organization should we create?” It is:

What useful community capacity already exists, what does it actually provide, who can access it, and where are the gaps?

Those gaps matter because community assets are not evenly distributed. A pathway in a central urban area may have access to more organizations, transportation options and specialized services than one in a rural, mountainous or geographically isolated setting. Digital connectivity, workforce availability and community infrastructure will also vary.

International evidence also shows that people facing poverty, transport barriers, digital exclusion, language barriers or lower trust in services may find it harder to reach and remain engaged with community support. Community-resource distribution is therefore also an equity issue.

A successful urban pilot should not automatically be copied elsewhere unchanged. Community capacity needs to be assessed locally.

Where formal organizations are fewer, useful assets may include existing public services, local associations, trusted community networks and community leaders rather than dedicated professional programs. These resources may still contribute meaningfully, but the pathway, expectations and level of support may need to look different.

Equity is not achieved simply by offering the same referral process everywhere. In some settings, greater investment may be needed precisely because community infrastructure is weaker.

Partnerships need relationships, feedback and shared design

A sustainable partnership is different from placing an organization's name in a directory.

Healthcare organizations and community partners need a shared understanding of what each party does, which people the resource is suitable for, how access works, whether there are costs or eligibility criteria, what information is necessary, what happens when capacity is full and how serious concerns should be escalated.

The appropriate level of formality will vary. Some low-risk relationships may work through simple communication and agreed processes. Others may require written agreements, funding arrangements, data-protection provisions or clearer allocation of responsibilities. The structure should be proportionate to the service, the information being exchanged and the level of risk.

Regular communication is important because community capacity changes. Staff leave. Volunteers change. Funding ends. Eligibility rules are revised. Programs move, pause or close. A directory that was accurate six months ago may no longer be reliable.

Community-connected care therefore needs a feedback loop. Community partners should be able to say when capacity has been reached, when a referral is not appropriate or when people repeatedly face the same barrier. Healthcare and navigation teams should be able to share concerns and learn whether referrals are actually producing useful connections.

A partnership should therefore not mean:

“Healthcare refers; community receives.”

It should mean:

“Both sides help maintain a workable pathway.”

This also requires sharing some of the power to design the pathway. Community organizations often know things that formal healthcare services do not: which activities local people actually trust, where transportation becomes a barrier, what language discourages participation, which resources are already overwhelmed, and which needs remain persistently unmet.

If healthcare defines the target population, referral criteria, outcomes and reporting requirements first and involves community organizations only afterward, partners may be asked to deliver a model they did not help shape and may not have the resources to sustain.

Sustainable partnerships are more credible when community partners participate early in decisions about referral mechanisms, workload assumptions, information sharing, implementation and evaluation.

Community capacity should therefore not be measured only by the number of people an organization can accept. It also includes the ability to participate meaningfully in the partnership itself.

What the Vietnamese legal context means for partnership

Viet Nam has several legal frameworks relevant to parts of this ecosystem, but none currently establishes a national social-prescribing system.

Decree No. 110/2024/ND-CP, effective from 15 October 2024, provides the national regulatory framework for social work. Circular No. 51/2024/TT-BYT, effective from 1 March 2025, regulates the implementation of social work in medical examination and treatment establishments and applies to establishments licensed to operate as hospitals. Circular No. 29/2026/TT-BYT, effective from 25 August 2026, regulates social-work practice and the updating of social-work knowledge.

These frameworks are highly relevant where professional social work participates in a pathway, but social work and social prescribing are not interchangeable concepts.

Potential community partners may also operate under different legal forms. Decree No. 126/2024/ND-CP, effective from 26 November 2024, regulates the organization, operation and management of associations. Decree No. 03/2026/ND-CP, effective from 1 March 2026, regulates social and charitable funds.

Not every useful community resource will have the same legal status, and some informal groups may not themselves constitute a separate legal entity. Funding, contracting, information-sharing and accountability arrangements therefore need to be considered according to the particular partner rather than assuming that one legal model fits the whole community ecosystem.

Data protection is another important part of partnership design. Law No. 91/2025/QH15 on Personal Data Protection and Decree No. 356/2025/ND-CP have both been in force since 1 January 2026. Where a social-prescribing pathway collects, processes or shares personal information — particularly health information — between healthcare organizations, navigators and community partners, applicable data-protection requirements need to be incorporated from the beginning rather than added after the referral process has been built.

None of these laws or regulations creates a legal category called a “social-prescribing community provider.” Future initiatives should therefore work with the actual legal status, responsibilities and capabilities of participating organizations instead of assuming that one standard contract or funding mechanism can be imposed across all community partners.

Viet Nam should adapt functions, not import the English model

Much of the international social-prescribing evidence comes from the United Kingdom. England in particular has developed primary-care networks, link-worker roles and relationships with voluntary and community organizations within a specific NHS policy and commissioning environment.

That experience offers useful lessons about funding stability, workforce support, referral pathways and community capacity. The organizational model itself, however, should not simply be transferred to Viet Nam.

Evidence from the Western Pacific shows substantial variation among countries in how initiatives are organized, financed and connected with community resources. Government, mixed, charitable, nongovernmental and private funding arrangements all appear in the literature, while the professionals and organizations involved differ substantially across settings.

For Viet Nam, the useful question is therefore not:

“How do we create a Vietnamese version of the English voluntary-sector commissioning system?”

It is:

“What combination of healthcare, public services, professional social work, associations, community organizations, private providers and local networks can create reliable community connection in this particular setting?”

This keeps the focus on functions rather than imported institutional labels.

Start small and scale with community capacity

An early Vietnamese pilot does not need an elaborate funding or contracting architecture. But it should account for the receiving side of the pathway from the beginning.

A pilot could start with a clearly defined population and a small number of community partners whose activities genuinely match the needs being addressed. Capacity should be discussed directly with those partners rather than inferred from a website or directory. Partners should agree on which referrals are appropriate, what information is genuinely necessary, how people will make contact, how much demand can reasonably be absorbed, and how changes in capacity will be communicated.

The project budget should include the work required to maintain these relationships, not only the navigator. If referrals create additional workload for community partners, that requirement should be visible rather than assumed away.

Training should remain proportionate. Healthcare professionals need to know when community support is appropriate and when another form of care is required. Navigators need competence in person-centered conversation, community resources, boundaries and escalation. Community partners need enough understanding of the pathway to know what is expected of them, without being unnecessarily turned into healthcare providers.

Capacity should then be monitored over time. Useful measures might include referral volume, referral acceptance, waiting time, completed connections, reasons referrals cannot be accepted, participation, community-partner workload, workforce turnover, volunteer availability, service interruptions and changes in resource availability.

A pilot should learn not only whether people were referred, but whether the community ecosystem was able to absorb those connections without becoming weaker.

The same principle should guide scaling. WHO's 2026 guidance on scaling public-health innovations is not specific to social prescribing, but it offers a relevant implementation principle: sustainable expansion requires country ownership, coordination across the system and supportive conditions rather than simply replicating a successful pilot.

That is particularly relevant here because social prescribing depends on people, organizations and relationships outside healthcare itself.

Before increasing referral volume, a program should therefore ask: Can navigators manage the caseload? Can community partners absorb additional demand? Is funding recurrent or temporary? Are rural and underserved communities developing sufficient capacity? Are referral patterns equitable? Can organizations continue participating without undermining their existing work?

If the answer to these questions is no, scaling referrals may make a program appear larger without making it more effective or sustainable.

From community resources to community infrastructure

Social prescribing is sometimes discussed as though community resources are simply “out there,” waiting for healthcare to discover them.

In reality, community capacity has to be maintained.

Organizations need people. People need support. Activities require space, time, coordination and sometimes funding. Information needs to stay current. Volunteers need boundaries. Partnerships require trust. Some resources will expand; others will disappear. Community needs will also change.

For Viet Nam, the stronger approach is therefore not to build social prescribing around a static directory of services. It is to develop community-connected care as living infrastructure, relationships among healthcare, social support, community organizations and local people that can adapt as needs and resources change.

That changes how success should be understood.

A successful social-prescribing pathway is not simply one that produces a high number of referrals. It is one in which appropriate people can reach useful support, community partners have sufficient capacity to respond, staff and volunteers can sustain their roles, and relationships remain strong enough to continue over time.

The community side of social prescribing should not be treated as an unlimited resource to which healthcare can transfer unmet need.

It should be treated as a partner that needs to be understood, supported, resourced and developed alongside the referral pathway itself.

For Viet Nam, that may be the difference between creating another short-lived pilot and building a genuinely sustainable model of community-connected care.

References

1. Kisa A, Kisa S. Models, implementation, and reported outcomes of social prescribing interventions: a scoping review. Frontiers in Public Health. 2026;14:1871347. doi:10.3389/fpubh.2026.1871347.

2. Lwin KS, Wong MSJ, Tan MH, et al. Organization and implementation of social prescribing in the Western Pacific Region: a scoping review. The Lancet Regional Health – Western Pacific. 2026;67:101714. doi:10.1016/j.lanwpc.2025.101714.

3. Vincent BP, Ali N, Egbutah C, Perkins K. Challenges and enablers of collaborative working in the voluntary, community, social, faith and enterprise sector: impact, effectiveness, and sustainability. Frontiers in Public Health. 2026;14:1763039. doi:10.3389/fpubh.2026.1763039.

4. Pywell S, Reynolds K, Kenyon A. Sustainable models of funding and resourcing nature based social prescribing in Lancashire and South Cumbria: a case study. Journal of Integrated Care. 2026. doi:10.1108/JICA-07-2025-0066.

5. World Health Organization Regional Office for the Western Pacific. A toolkit on how to implement social prescribing. Manila: WHO Regional Office for the Western Pacific; 2022.

6. World Health Organization. Scaling innovations in public health systems: guidance and toolkit. Geneva: WHO; 2026.

7. Prime Minister of Viet Nam. Decision No. 1648/QĐ-TTg approving the project to expand Intergenerational Self-Help Clubs through 2035. 1 August 2025.

8. Government of Viet Nam. Decree No. 110/2024/ND-CP on Social Work. Effective 15 October 2024.

9. Ministry of Health of Viet Nam. Circular No. 51/2024/TT-BYT on the implementation of social work in medical examination and treatment establishments. Effective 1 March 2025.

10. Ministry of Health of Viet Nam. Circular No. 29/2026/TT-BYT on social-work practice and updating social-work knowledge. Effective 25 August 2026.

11. Government of Viet Nam. Decree No. 126/2024/ND-CP on the organization, operation and management of associations. Effective 26 November 2024.

12. Government of Viet Nam. Decree No. 03/2026/ND-CP on the organization and operation of social and charitable funds. Effective 1 March 2026.

13. National Assembly of Viet Nam. Law No. 91/2025/QH15 on Personal Data Protection. Effective 1 January 2026.

14. Government of Viet Nam. Decree No. 356/2025/ND-CP detailing certain articles and measures for implementation of the Law on Personal Data Protection. Effective 1 January 2026.