Co-Designing Social Prescribing in Viet Nam: How Can People, Communities and Providers Shape Pathways That Fit Local Needs?

Co-Designing Social Prescribing in Viet Nam: How Can People, Communities and Providers Shape Pathways That Fit Local Needs?

Category: Implementation & Practice

A social prescribing pathway can look convincing on paper and still fail in practice. A hospital may identify an appropriate target population, a referral form may be well designed, a navigator may be appointed, and community resources may already exist. But the people expected to use the pathway may find it confusing or unhelpful. Community organizations may receive referrals they are not equipped to support. Healthcare professionals may not know when community support is appropriate. And practical barriers that seem minor during planning may become the reasons people never reach the support intended for them.

This is why designing social prescribing is not only a technical exercise. The people who use, deliver and receive referrals see different parts of the pathway. Someone living with a long-term condition knows what it is like to manage daily barriers between healthcare encounters. A caregiver may understand why appointments or community activities are difficult to attend. A social worker sees needs that do not fit neatly into clinical categories. A community organization knows what it can realistically provide and what would overwhelm its capacity. Healthcare professionals understand clinical responsibilities and workflow constraints.

Co-design brings these different forms of knowledge into the process before important decisions become fixed.

For Viet Nam, this is particularly relevant. Social prescribing remains at an early stage, and there is no established national model that can simply be copied from England, Singapore or another health system. A 2026 Western Pacific review included 42 peer-reviewed studies and 13 grey-literature sources, but only one peer-reviewed study came from Viet Nam. Models across the region differed substantially in structure, funding, workforce, referral arrangements and community involvement. The implication is not that Viet Nam needs to wait for a complete evidence base, but that pathways should be structured enough to be workable while remaining adaptable to local systems and community strengths.

The question is therefore not simply “Which international model should Viet Nam adopt?” A more useful question is: “How can the people who will use, deliver and support the pathway help shape something that works in this particular Vietnamese setting?”

Co-design means influence, not simply feedback

The language around participation can be confusing. Co-design, co-creation, co-production, consultation and community engagement are used inconsistently across health and social care. A large systematic scoping review found substantial variation in how co-design and co-production have been defined and applied. For that reason, the degree of participation and influence often matters more than the label alone.

For social prescribing, a practical distinction can still help. Consultation usually means that an organization develops an idea and asks people for views or feedback. That can be entirely appropriate when some decisions are already constrained and the organization genuinely intends to use what it hears. Co-design goes further: people with lived experience, community partners and professionals become involved while important elements of the pathway are still being shaped. They can help define the problem, challenge assumptions, explore alternatives, test proposed processes and influence decisions. Co-production may extend participation further into implementation, delivery, governance or evaluation, although terminology varies considerably between settings.

The point is not that co-design is automatically superior to consultation. A transparent consultation can be more respectful than a process called “co-design” when every meaningful decision has already been made.

The more useful test is how much influence participants actually have. If people attend a workshop, share their experiences and later discover that the target population, referral pathway, eligibility criteria and key decisions had already been finalized, the process was not meaningfully co-designed.

What does the latest evidence actually support?

The most recent dedicated review of inclusive co-design for social prescribing was published in Health Expectations in July 2026. It synthesized 52 sources and organized its findings around three interconnected domains: foundational principles, enabling structures and operational practices. Foundational principles included equality, diversity, relationship-centeredness and reciprocity. Enabling structures included leadership, adequate resources, accessibility and participatory governance. Operational practices included thoughtful recruitment, developing shared understanding, addressing power imbalances, preparing participants and inclusive facilitation.

The limitations are just as important. Only eight of the 52 included sources were empirical studies. The remaining sources included reviews, conceptual and practice papers, books and chapters, reports, toolkits and other grey literature. The review was designed as a structured narrative synthesis rather than an effectiveness review, and it did not establish that one form of co-design produces better health or implementation outcomes than another.

The evidence therefore does not justify saying that co-design has been proven to make social prescribing effective.

A more accurate conclusion is that inclusive co-design provides an ethically and practically credible approach for developing pathways that are more responsive to local realities, while comparative empirical evidence about which approaches work best remains limited.

That distinction matters. Co-design should be used as a process for learning, sharing influence and improving contextual fit — not as another fashionable label that guarantees success.

Recent conceptual work makes a related argument. Mulligan and Bloch challenge approaches that focus too narrowly on delivering discrete “social prescriptions” and argue for a more relational understanding of social prescribing centered on relationships, co-creation, community participation and self-determination. This is a conceptual argument rather than effectiveness evidence, but it reinforces an important point: how a pathway is created and how people participate in it may be as important as the list of activities to which they are eventually connected.

Start with the problem, and involve people who can see it differently

One of the easiest mistakes would be to select an established social prescribing model first and then ask Vietnamese participants how it should be implemented. That may be useful adaptation, but it is not necessarily co-design.

A stronger process begins earlier. Before deciding that a hospital needs a particular type of link worker, referral form or digital platform, local participants should first ask what problem they are trying to solve. Where are people currently falling between services? Which non-clinical needs repeatedly affect health and well-being? Which needs can existing services already address? Where are the genuine gaps? Who already helps people navigate those gaps, even if that work has never been called social prescribing?

The WHO Western Pacific toolkit already recognizes that social prescribing needs to be adapted to local healthcare, community and long-term care contexts. Co-design can take that principle further by involving local people and organizations in defining the problem itself rather than merely adapting a predetermined solution.

A hospital, for example, may initially believe that the main problem after discharge is a shortage of community activities. Patients and families may reveal that transportation is the more important barrier. Community organizations may explain that appropriate activities already exist but hospital teams do not know about them. Social workers may identify people whose needs require professional intervention rather than community connection. A navigator may discover that the major gap is not making the referral but knowing what happens when it fails.

The pathway designed after those conversations may look very different from the one originally imagined.

Who participates will depend on the problem and setting. A hospital-based pilot might involve people who have used the relevant services, caregivers where appropriate, clinicians, hospital social workers, potential navigators, operational staff and community organizations. Other settings will require different voices. The objective is not to place every possible organization around one table. The more useful question is: whose experience is necessary to understand this pathway, and whose absence could create a serious blind spot?

The 2026 review emphasizes intentional diversity rather than simply recruiting the people who are easiest to reach. Recruiting only professionals can produce a pathway that is internally coherent but difficult for people to use. Recruiting only confident and highly engaged community representatives can also miss the experiences of people with limited mobility, less flexible employment, lower digital access, weaker social connections or less comfort speaking in institutional settings.

Representation does not need to be statistically perfect. It does need to be purposeful and honest about whose voices are still missing.

Meaningful participation also requires practical support. Inclusive co-design literature highlights accessible venues, flexible scheduling, understandable information, transportation support, translation or interpretation where needed, digital access and appropriate recognition of non-salaried participants' time and expertise. Depending on the setting and organizational arrangements, a project may also need to budget for transport, accessibility, interpretation, venues or reasonable participant reimbursement or compensation.

These are not minor logistical details. They influence who is actually able to participate.

If workshops always take place during working hours, some people will disappear from the process. If participation requires a long journey, people with mobility or transport barriers may be excluded. If every document uses specialist terminology or unnecessary English, professional participants immediately have an advantage.

Co-design therefore needs a budget.

Power also needs active attention. A hospital director, doctor, patient, community worker and volunteer do not automatically have equal influence because they are seated around the same table. Differences in status, expertise, institutional authority, confidence and language continue to affect who speaks and whose ideas carry weight.

The 2026 review identifies managing power imbalances as a central operational practice. Approaches can include openly acknowledging power differences, setting group norms, using skilled facilitation, providing more than one way to contribute, monitoring who dominates discussions and deliberately creating space for participants who speak less.

Power needs to be designed for, not assumed away.

Co-design the pathway, not just the list of community activities

Groups often move too quickly to solutions. Someone proposes a navigator. Someone else suggests a digital directory. Another person wants a referral form. Soon a pathway is being designed before participants have agreed on the underlying problem.

Inclusive co-design literature emphasizes developing a shared understanding first. Storytelling, journey mapping, observation, experience mapping and contextual enquiry can help participants understand where needs emerge, how the current system responds and where people become disconnected.

For Viet Nam, mapping a person's actual journey could be particularly useful. Imagine someone living with diabetes who is socially isolated and facing financial difficulty. Where does that need first become visible? What happens if they tell a clinician? Who responds now? Which services exist? Which information needs to move? Where might the person disengage? What burden falls on the family? What happens if the community resource has no capacity?

Another person's journey may begin in the community rather than in a hospital. Mapping several real journeys can quickly demonstrate why one universal pathway may not work.

The pathway itself contains many design decisions: who can enter it, how needs are identified, whether self-referral is possible, what a navigator does, how community resources are assessed, what information is shared, what happens when risk is identified, how an unsuccessful connection is handled, whether a community partner can refer someone back, and which outcomes should be evaluated.

These are decisions where healthcare, community and lived-experience perspectives may legitimately differ.

A recent BMC Primary Care paper describes the use of deliberative dialogues to co-design social prescribing pathways with primary-care providers and community organizations. The paper was first published online in December 2025 and appears in the journal's 2026 volume. Structured discussions were used to identify feasible pathways, core components and implementation barriers. Early engagement helped identify local champions, build relationships across sectors and develop more contextually relevant approaches.

Viet Nam does not need to reproduce deliberative dialogue exactly. The broader lesson is that structured participation becomes particularly useful when people work through real trade-offs rather than simply brainstorm ideas.

Should an early pilot accept everyone or start with a defined population? Who follows up when a connection fails? What happens when a community organization has no capacity? Which information genuinely needs to move between organizations? When does a social need require professional social work rather than social prescribing? When should a person return to clinical care?

Those questions are the pathway.

Recent empirical work also reinforces the importance of individual context. A multi-country co-creation study published in September 2026 involved four consultations and six co-production workshops across Berlin, Aalborg and Bern to explore social prescribing for people in potentially vulnerable situations. Participants emphasized sensitive conversations about social circumstances, flexible and person-centered link-worker support, and a range of community options reflecting individual interests rather than assigning activities primarily according to target-group membership. The study also highlighted the tension between understanding needs associated with particular populations and avoiding stereotypes about individuals.

That is highly relevant to Viet Nam. A pilot may legitimately focus on older people, people with diabetes or another defined population. But the person should never be reduced to the category used to define the pilot.

Community asset mapping can also use participatory methods. Singapore's Living Asset Map Project provides one Western Pacific example. In the 2026 participatory-action-research study, social-prescribing practitioners contributed to platform development and validation through interviews, field validation and community walks. Controlled crowdsourcing helped identify informal community resources that formal lists could overlook, while also exposing challenges involving data quality, organizational incentives, participation and sustainability.

The study primarily involved social-prescribing practitioners rather than representing a broad community co-design process, so its conclusions should not be extended too far. Its practical lesson is nevertheless useful: asset mapping does not have to happen only behind a computer. People can test directories, walk through neighborhoods, verify resources and identify accessibility or information problems in the real environment.

A map, however, is still not a referral network. Community resources need to be understood in terms of what they provide, whom they can support, how accessible they are, whether they currently have capacity and what governance is appropriate.

Meaningful participation requires clear boundaries, governance and privacy

The language of co-design is attractive, which creates a risk of tokenism.

An organization can hold a workshop, invite people to tell their stories, photograph the event and describe a program as co-designed while retaining control over every meaningful decision. The 2026 review warns that superficial or tightly controlled participation can contribute to frustration, emotional fatigue, disengagement and loss of trust.

Several questions can expose this risk. What decisions can participants genuinely influence? Which decisions are already fixed? Who decides when participants disagree? How will people know what happened to their recommendations? Is the organization genuinely prepared to change its original idea? Are people repeatedly being asked to share difficult personal experiences without seeing any visible result?

A credible process should answer these questions early.

Some things genuinely are not open to co-design. A hospital cannot collectively redesign away professional licensing requirements, clinical accountability, legal obligations or patient-safety requirements. A project may have a fixed budget. A research protocol may impose methodological limits.

There is nothing wrong with boundaries. The problem arises when something is presented as open to shared design when it is not.

This is particularly important in Viet Nam because co-design does not replace existing professional or legal responsibilities. Decree No. 110/2024/ND-CP, effective from 15 October 2024, provides the general 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 instruments do not establish social prescribing, and professional social work should not be relabeled as social prescribing. They do matter, however, when a proposed pathway enters areas requiring professional social-work competence or accountability.

The same principle applies to healthcare. People and communities can help shape how a pathway works, what barriers matter, what support feels acceptable and which outcomes should be measured. Co-design does not transfer clinical decisions to people who do not hold the relevant professional responsibilities.

Community participation and professional accountability should complement one another.

Privacy also needs attention because co-design frequently involves personal stories. Participants may discuss illness, mental health, finances, disability, caregiving, family circumstances or other sensitive experiences.

Viet Nam's 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 identifiable personal information is collected, recorded, processed or shared during pathway development, evaluation or research, applicable data-protection requirements need to be considered. Health information receives specific protection under the Law, including consent requirements subject to statutory exceptions.

Co-design teams should therefore decide in advance what information genuinely needs to be recorded, why it is needed, who can access it, whether personal stories or quotations may be reused and how participants will be informed. If the work constitutes research, relevant research-ethics requirements may also apply depending on the project and institution.

People should not have to surrender unnecessary personal information simply to have a voice in improving a pathway.

A practical co-design process for an early Vietnamese pilot

Viet Nam does not need a national consultation before it can learn how co-design works. A stronger starting point is a small, clearly defined pilot.

The process should begin by choosing a setting and a problem rather than a predetermined solution. A hospital might explore community connection after discharge for a defined group of older patients. Another setting might focus on non-clinical barriers affecting people living with long-term conditions. A community-based initiative might begin somewhere else entirely.

Before inviting participants, the project should clarify which decisions are genuinely open to influence and which are constrained by law, safety, professional responsibilities, organizational resources, budget or research requirements. People should understand these boundaries before investing their time.

The next step is to bring together relevant lived and professional perspectives and develop a shared picture of the current journey. Instead of immediately drawing the new pathway, participants can identify existing resources, duplicated functions, gaps, bottlenecks and points where people currently become disconnected.

Only then should the pathway be designed.

Participants can work through realistic scenarios. How does someone enter the pathway? Who has the first conversation? When is navigation enough, and when is professional social work or clinical care required? How is a community resource selected? What information needs to be exchanged? What happens when the resource is full? How does the person return to healthcare or another professional service when community support is not enough?

The emerging pathway should then be prototyped rather than treated as finished.

A small number of real cases can reveal problems that no workshop anticipated. People using the pathway, staff and community partners should be brought back after early implementation to examine what happened and modify the design.

Co-design is therefore better understood as an iterative relationship than as a single workshop before launch.

People should also help define what success means

Co-design should not stop once the referral diagram has been drawn.

The 2026 review raises a deeper question: who decides what counts as success? Healthcare organizations may naturally focus on referral numbers, service utilization or clinical outcomes. People using the pathway may place more importance on dignity, trust, confidence, belonging, social connection, autonomy or whether the support helped them do something meaningful in daily life.

Both perspectives can matter.

A pilot should still measure implementation rigorously: eligibility, referrals, completed connections, waiting times, unsuccessful connections, safety issues, community capacity and relevant health or well-being outcomes. But the outcome set should not be chosen exclusively by the organization delivering the program.

This does not mean every outcome proposed by participants must be measured. It means that deciding what matters is itself a legitimate part of co-design.

The co-design process should also be evaluated. Who participated? Who was missing? Did participants believe they influenced decisions? Were community organizations adequately supported? Did participation create avoidable burden? Were recommendations acted upon? Did people understand why some suggestions could not be implemented?

If the resulting pathway appears successful but the development process damages trust or exhausts community partners, that is also important implementation information.

Co-design should change the pathway, or it should be called something else

The most useful test of co-design is not whether workshops took place. It is whether participation changed understanding, decisions or implementation in ways that probably would not have happened otherwise.

Perhaps community organizations explain that the original referral criteria would overwhelm their capacity. Perhaps people with lived experience show that a digital-first pathway would exclude many users. Perhaps social workers identify that a proposed navigator role duplicates existing functions. Perhaps families reveal that transportation, rather than the absence of community activities, is the real barrier. Perhaps people simply say that they do not want the kind of support the project originally intended to offer.

Those are not failures of co-design.

They are the reason to do it.

For Viet Nam, where direct local evidence on social prescribing remains very limited, there is little advantage in fixing a model too early and discovering later that it does not fit the people, community organizations or health system expected to use it.

A more responsible approach is to define the problem locally, design with the people and organizations affected, test the pathway on a manageable scale, learn from what happens, and adapt before expanding.

Recent conceptual work on social prescribing supports this broader direction by arguing for movement beyond transactional “social prescriptions” toward a more relational process centered on relationships, co-creation, community participation and self-determination.

Co-design does not guarantee that a social-prescribing pathway will work.

But it can help prevent a more basic mistake: building a pathway for people and communities without meaningfully involving them in deciding what that pathway should be.

For SPVN, that may be the most important reason to use co-design. The objective is not to import a finished model and persuade Viet Nam to adopt it. It is to develop community-connected care that is locally grounded, person-centered, implementable and capable of changing as Vietnamese communities and health systems learn what works.

References

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

11. 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.

12. 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.

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.