From Pilot to Sustainable Scale-Up: When Is Social Prescribing Ready to Expand in Viet Nam?
VIET NAM CONTEXT
From Pilot to Sustainable Scale-Up: When Is Social Prescribing Ready to Expand in Viet Nam?
Category: Viet Nam Context
A successful pilot creates an understandable temptation: if the pathway appears to work for a small group of people, why not offer it to more people, in more services and across more locations? The question is reasonable, but it can also be premature. A pilot often operates under conditions that may not survive expansion. Staff may be unusually motivated, navigators may carry relatively small caseloads, community partners may know the project team personally, problems can be solved informally, and funding may be protected for a limited period. As the number of participants, sites, organizations and community partners grows, many of those advantages can disappear.
For social prescribing, scale-up is therefore not simply a larger version of implementation. Scale changes the implementation problem. A pathway that works for 30 people may not work in the same way for 300, and a model that functions in one hospital, primary-care setting or community network may perform very differently elsewhere.
This distinction is particularly important for Viet Nam. Social prescribing has not been established as a national service model, and the Vietnamese research base remains very limited. A 2026 Western Pacific scoping review identified 42 peer-reviewed studies and 13 grey-literature sources across the region, with only one peer-reviewed study from Viet Nam. Models varied substantially in structure, funding, delivery mechanisms and population reach. The review supports an approach to development and scale-up that is structured enough to guide implementation but flexible enough to reflect local health systems and community strengths.
The question for Viet Nam should therefore not be, “How quickly can a successful pilot become a larger program?” A more useful question is: “What have we learned that makes expansion responsible, and what conditions need to remain in place when the pathway becomes larger?”
Scale-up is more than adding sites and referrals
The word “scale” can describe several different changes. A program may expand from one population to another, from one department to an entire organization, from one organization to several, or from one district or city to a wider geographic area. It may also become more institutionalized through permanent staffing, formal partnerships, routine financing, digital infrastructure and integration into everyday care. These forms of expansion do not create the same challenges. Adding another 50 participants to an established pathway is different from introducing the model into five organizations with different leadership, workforces, community resources and referral practices. Geographic expansion may introduce differences in transport, digital access and community infrastructure, while expansion to another population may change the complexity and risk profile of the people entering the pathway.
Implementation research more broadly suggests that successful scale-up cannot be reduced to population reach. A 2025 international study of 35 scaled physical-activity and nutrition interventions found no single definition of scale-up success. Stakeholders considered sustained implementation quality, equitable reach, organizational and system capacity, funding and other resources, partner engagement and contextual fit alongside population coverage.
This is particularly relevant to social prescribing because the intervention is not a single product. It is a network of relationships between people, health and care services, navigators and community resources. Expanding one part of that network without strengthening the others can weaken the pathway rather than improve it.
A pilot should answer readiness questions before it creates a scale-up plan
A pilot does not need to prove that social prescribing is effective everywhere before any expansion can occur. It should, however, generate enough knowledge to show that the pathway being expanded is understandable, feasible and reasonably safe. The organization should know who the pathway is intended for, how people enter it, what navigators actually do, which community resources are realistic partners, what happens after referral, where professional responsibilities sit and how safety concerns are escalated. It should also understand where people leave the pathway and why, and what workload is being created for healthcare staff, navigators and community organizations.
A pilot that reports high satisfaction but cannot explain how many potentially eligible people were never offered the pathway provides a weak basis for scale. The same is true of a pilot that records large numbers of referrals without knowing whether people actually reached community support, or a pathway that depends heavily on one unusually committed individual whose work has never been translated into processes that others can reproduce.
This does not mean everything should be standardized before expansion. Social prescribing is inherently contextual. The more useful distinction is between core functions that need to remain reliable and forms that can adapt as the pathway moves into new settings. For example, a core function might be that an unsuccessful community connection becomes visible and can be followed up when appropriate. One site might achieve this through a secure tracker, another through an electronic referral platform and another through structured telephone communication. The form can change; the function should not disappear.
Evaluate according to the stage of implementation
A particularly useful development for the Western Pacific appeared in 2026. A Viewpoint commissioned by the WHO Regional Office for the Western Pacific proposed a stage-sensitive approach to social-prescribing evaluation organized around four implementation stages: exploration, installation, initial implementation and full implementation. Rather than expecting the same questions and methods to work at every stage, the authors argue that evaluation should evolve as implementation develops.
This principle is highly relevant to Viet Nam. During exploration, the most useful questions may concern whether there is a meaningful local problem, whether suitable community assets exist, whether people and organizations see value in the concept and what form of social prescribing might fit the setting. During installation, attention shifts toward pathway design, workforce preparation, partnerships, information flows, governance and infrastructure. Initial implementation then asks whether the pathway works when real people begin using it: Are referrals appropriate? Do navigators have enough time? Are community connections occurring? Are safety concerns visible? Are people being missed? Are community partners becoming overloaded?
As implementation matures, questions increasingly concern sustainability, institutionalization, equity and the ability to expand without losing the functions that made the original pathway workable. This avoids two opposite mistakes: demanding population-level outcome evidence from a small early pilot before its delivery system is stable, or moving rapidly toward scale simply because the pilot showed that the pathway was technically possible. The evidence expected from a program should mature as the program matures.
Readiness depends on whether people actually reach support
Referral volume should not be the main argument for expansion. What matters is what happens between being offered a pathway and actually engaging with useful community support.
A Bayesian re-analysis published in September 2026 examined randomized evidence involving 4,840 participants and found that, within the included studies, sustained participation appeared more strongly associated with benefit than referral alone. However, eight of the nine trials were exercise-oriented and only one evaluated a link-worker model, so these findings should not be generalized to all forms of social prescribing. Importantly, the adherence-based analyses involved post-randomization comparisons and therefore should not be interpreted as proving that participation itself caused the observed benefits.
The implementation lesson remains useful: referral volume alone tells us little about whether people actually engage with support. Before scaling, an organization should understand the journey from eligibility to offer, acceptance, navigation, contact with a community resource and meaningful engagement. If large numbers of people disappear between referral and connection, increasing referral capacity may simply increase the number lost in the pathway.
Reasons for non-connection also matter. One person may make an informed decision not to proceed, while another may face transport costs, unsuitable opening hours, disability-access problems, limited digital access or language barriers. A community organization may simply have reached capacity. These situations require different responses. A pathway is more ready to scale when it can see these differences and learn from them, rather than reporting every unsuccessful connection as the same kind of failure.
Workforce capacity must grow before referral demand does
A small pilot can make navigation look easier than it will become at scale. Navigators may initially have enough time for longer conversations, active follow-up, community relationship-building and case discussion. As referral volume rises, that relational work can be compressed.
A 2026 multi-region qualitative study involving 130 stakeholders across England and Scotland examined the experience of embedding social prescribing in primary care. It identified increasing complexity in the needs being referred, alongside workload pressures, role-boundary problems, burnout, retention challenges, variable support and short-term funding. Sustainability was threatened not simply by the number of referrals but by the increasing complexity of what link workers were expected to manage.
A Vietnamese scale-up plan should therefore include a realistic workforce model before referral targets increase. How many people can a navigator support while maintaining the level of relationship the pathway requires? How much time is needed for community relationship-building, documentation and follow-up? What training and supervision are available? What happens when someone presents with needs beyond the navigator's competence?
There is no universal caseload number that SPVN should recommend. Caseload depends on population complexity, pathway design, the intensity of navigation and the surrounding community infrastructure. A model based mainly on light navigation is different from one requiring repeated contacts with people facing several interacting barriers. Do not scale demand faster than the capability to navigate it safely.
Community capacity is part of scale-up capacity
The receiving side of social prescribing can easily become invisible during scale-up planning. A healthcare organization may conclude that it can double referrals because it has recruited another navigator, but community organizations do not automatically double their spaces, staff, volunteers or funding. If the receiving ecosystem cannot absorb greater demand, healthcare-side expansion can make the pathway worse.
The 2026 global scoping review of 115 empirical social-prescribing studies identified limited community-sector capacity, unstable funding, workforce pressures and uneven infrastructure among recurring implementation barriers. It also highlighted the importance of clear pathways, defined roles, cross-sector communication, workforce support and adequate community capacity.
This is particularly important in Viet Nam because community assets will not all resemble formal service providers. Some may be professional organizations with staff and structured programs. Others may be clubs, local groups, voluntary organizations, neighborhood networks or informal activities with little administrative infrastructure.
Scale-up should therefore assess the community's capacity to absorb additional referrals, rather than simply count the number of resources listed in a directory. Does the resource genuinely have capacity? Can it accommodate the intended population? Is participation affordable and geographically accessible? Does the organization need additional coordination, training or funding because of the referral pathway? Can it communicate with navigators without being turned into an administrative extension of healthcare?
If expansion creates substantial additional work for community organizations, sustainable financing should consider that work rather than funding only the healthcare-facing components of social prescribing.
Sustainable expansion requires relationships, not just standardized procedures
Standard operating procedures matter at scale, but they are not enough. Relationships remain part of the infrastructure. A 2026 Danish ethnographic study found that implementation work was distributed across multiple actors rather than being carried by the link worker alone. General practitioners, link workers, a Volunteer Centre and the DaneAge Association performed different functions. The researchers identified mechanisms involving legitimacy, standardization and normalization, relational sense-making and trust-building, network formation and knowledge mobilization.
The study did not demonstrate that those mechanisms necessarily produced better health outcomes, nor should the Danish organizational structure be treated as a template for Viet Nam. Its more transferable insight is that social prescribing operates as a system-embedded, multi-actor implementation process rather than a set of isolated techniques that can simply be copied.
For Viet Nam, this means scale-up should not consist only of reproducing referral forms, navigator training or digital tools. Relationships between healthcare organizations, professional social work, community organizations and other local actors need to be developed within each setting. Some elements can reasonably be standardized, including minimum role boundaries, safety requirements, essential documentation, data-governance expectations and escalation principles. Other elements may require substantial local adaptation, including the community-resource network, referral routes, communication channels and intensity of navigation. Responsible scale-up therefore combines standardization where consistency protects quality and safety with adaptation where local context determines whether the pathway can work.
Equity can improve with scale, or deteriorate
Expansion increases reach, but greater reach does not automatically mean greater equity. A pilot may initially involve people who are easiest to identify, contact and engage. As the program expands, people facing greater barriers may become a larger proportion of those served. Alternatively, the pathway may continue reaching the same relatively accessible groups while appearing increasingly successful because overall numbers rise.
Scale-up should therefore ask whether the pathway's reach reflects the population it is intended to serve. Relevant questions may involve disability, geography, digital access, socioeconomic constraints, language, caregiving responsibilities or other barriers relevant to the particular setting. These factors should be selected because they matter locally, not because an international checklist says they must all be measured.
Scale can also create inequities between places. A pathway that works in an urban area with dense community infrastructure may be much more difficult to reproduce where suitable resources are sparse or geographically dispersed. Scaling the referral mechanism without addressing those differences can create the appearance of geographic coverage without equivalent access to meaningful support.
In some circumstances, the more responsible approach may therefore be uneven but deliberate expansion: adapting the model to different contexts rather than expecting every setting to implement the same pathway at the same pace.
Funding needs to cover the system that makes social prescribing possible
Pilot funding can hide the true cost of a model. Staff may contribute time that is not fully recorded. Community organizations may absorb referrals without reimbursement. Project leaders may provide coordination beyond their formal roles, while technology and infrastructure may be borrowed from existing systems. These contributions can make a pilot appear less expensive than routine delivery would actually be.
Economic evidence should inform scale-up, but it needs cautious interpretation. A 2026 systematic review identified only 18 studies with a health-economic component and concluded that robust international evidence on cost-effectiveness, cost-utility and value for money remains limited. Several Social Return on Investment analyses reported positive returns, but methods and outcomes were heterogeneous, and standard economic methods were used inconsistently.
Viet Nam should therefore avoid two opposite mistakes. One would be requiring a small pilot to provide definitive cost-effectiveness evidence before any further implementation can occur. The other would be claiming that social prescribing will save healthcare costs simply because some international programs have reported favorable economic findings.
Before expansion, the more practical questions are whether the true delivery costs are understood, whether funding is sufficiently predictable for the next stage and whether resources cover the parts of the system on which the pathway depends. These include navigation, supervision, partnership management, community capacity, information systems, evaluation and governance — not merely the act of generating referrals. Short-term project funding can be entirely appropriate for learning; it is a weak foundation for describing an intervention as sustainable.
Governance needs to become stronger as the network becomes larger
Informal coordination can work surprisingly well in a small pilot. People know one another, unusual situations can be discussed quickly and problems can often be resolved through direct communication. That flexibility becomes harder to sustain as more sites and organizations join.
Scale-up therefore requires clearer governance, although not necessarily more bureaucracy. Someone needs authority to make decisions about the pathway. Responsibilities for workforce, partnerships, safety, complaints, information governance and evaluation need to be visible. Community organizations should have meaningful participation in governance rather than being treated simply as referral destinations, and there should be a mechanism for reviewing recurring failures and changing the pathway across sites.
The legal context becomes more important as a model expands. Decree No. 110/2024/ND-CP on Social Work, effective since 15 October 2024, regulates social work and social-work practice. From 1 January 2027, people practicing social work must hold the applicable social-work practice registration certificate in accordance with the Decree. Circular No. 29/2026/TT-BYT, effective from 25 August 2026, further regulates social-work practice and the updating of social-work knowledge. For hospitals, Circular No. 51/2024/TT-BYT, effective from 1 March 2025, regulates social-work services and processes in medical examination and treatment establishments licensed to operate in the form of hospitals.
These instruments do not establish social prescribing as a national Vietnamese service model. They do mean that scale-up should not blur the boundaries between community navigation, regulated social-work practice and clinical functions. A role that was clearly bounded in a small pilot may gradually accumulate additional responsibilities as demand increases. Governance should detect that change rather than assuming that the original job title determines the regulatory position.
Data systems should scale only as far as the pathway needs
As a pilot grows, pressure often develops for a common digital platform. This can be useful because larger networks need ways to know whether referrals were received, whether connections occurred, whether people are being lost and where capacity problems are emerging. But expanding data collection also expands technical and governance responsibilities.
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 scale-up involves personal data relating to health, Article 26 of the Law requires the data subject's consent for collection and processing except in the circumstances specified in Article 19(1). Decree No. 356/2025/ND-CP includes health status among categories of sensitive personal data.
Expansion involving more organizations, more authorized users and more data flows therefore requires renewed attention to purpose, necessity, consent where applicable, access control, security, retention and the handling of sensitive information. A pilot's information arrangements should not simply be copied into a larger network without review. A secure tracker used by three authorized staff members creates a different risk environment from a multi-organizational referral platform, while a community partner receiving a person's name and contact information raises different questions from one receiving detailed health, psychosocial and longitudinal outcome data.
Scale-up is therefore a useful moment to ask whether every data element still serves a clear purpose. More participants do not justify collecting more information about each person. The information system should support care navigation, accountability, safety and learning without turning community-connected care into unnecessary surveillance.
Scale the learning system as well as the service
One of the biggest risks of scale-up is that learning slows down just as complexity increases. During a pilot, teams often meet frequently, review individual cases and make adjustments quickly. Once a program is considered “implemented,” attention can shift toward throughput and routine performance reporting. The pathway becomes larger while becoming less able to notice when conditions have changed.
That is precisely when learning needs to continue. The 2026 stage-sensitive evaluation approach emphasizes continued adaptation, participatory evaluation and methods suited to complex and evolving systems rather than treating implementation as complete once a program reaches a particular stage. The Danish implementation study similarly illustrates that knowledge mobilization and iterative sense-making remain active parts of implementation rather than temporary activities that disappear after launch.
At scale, implementation data should therefore continue to answer practical questions. Are referral patterns changing? Are particular community resources becoming overloaded? Are navigators seeing increasingly complex needs? Are connection rates falling as referral volumes rise? Are different sites adapting the pathway in ways that strengthen or weaken its core functions? Are particular groups being missed?
A scalable model is not one that never changes. It is one that can change deliberately without losing the functions that make it safe and useful.
Readiness for scale should be a decision, not an assumption
There is no internationally validated score that can tell a Vietnamese organization that its social-prescribing pilot is “82% ready to scale.” Creating such a score would imply more certainty than current evidence supports.
Readiness can nevertheless be assessed systematically. Before expansion, decision-makers should be able to explain whether the pathway is sufficiently acceptable and feasible, whether important safety problems are controlled, whether intended connections actually occur, whether the workforce can absorb additional demand, whether receiving community organizations have realistic capacity, whether important equity barriers are visible, whether governance and data arrangements remain appropriate, whether funding can support the next stage and whether there is a credible process for continuing evaluation.
Not every weakness requires stopping. Some problems can be addressed while expansion proceeds cautiously; others should change the decision. This creates more useful options than a simple scale / do not scale choice. A pathway may be ready to expand because its core functions are sufficiently reliable and the next setting has adequate capacity. It may be better to expand selectively, for example to another population or site with similar conditions while postponing wider geographic expansion. It may need to adapt and retest because significant but potentially solvable problems remain. It may need to pause because workforce, community capacity, equity, safety or governance is inadequate. In some circumstances, the responsible conclusion may be not to scale the model in its current form.
A pilot that leads to that conclusion has not necessarily failed. It may have prevented a small and manageable problem from becoming a much larger one.
What might responsible scale-up look like in Viet Nam?
For Viet Nam, a sensible pathway is likely to be staged rather than national from the outset. A healthcare organization or local partnership might first demonstrate that a clearly defined pathway works reasonably well for one population and a manageable set of community resources. The next step could involve another service or location with enough similarity to test whether the core functions can be reproduced, but enough difference to reveal what requires adaptation.
Expansion should be accompanied by deliberate comparison. What remained stable? What had to change? Did the same workforce model still work? Were comparable community resources available? Did referral and connection patterns change? Did navigator workload or delivery costs increase? Did new professional, safety or data-governance issues emerge?
Across several implementations, this process could begin to show which components are consistently important in Vietnamese settings and which need local variation. That knowledge would be far more useful for future policy than prematurely declaring one pilot to be “the Vietnamese model” of social prescribing.
The 2026 Western Pacific review is particularly relevant here because it demonstrates substantial variation in social-prescribing approaches across the region and supports development that combines structure with flexibility according to local systems and community strengths. A 2026 Viewpoint describing the CONNECT Initiative in Lao PDR also offers a useful example of how a community-led approach in a lower-resource setting may differ from conventional high-income-country link-worker models. Community members identify vulnerable groups and locally important needs and work with authorities and health staff on solutions. The authors emphasize participation, trust and co-production and suggest that this process may in some respects be better understood as co-production rather than prescribing.
This is not evidence that Viet Nam should reproduce the Lao model. It reinforces a broader point: social prescribing and community-connected care may need to take forms that reflect local institutions, relationships and community capacity rather than reproducing models developed elsewhere. Viet Nam therefore does not need to decide now what a fully scaled national social-prescribing system should look like. It needs to build enough local implementation knowledge to make future decisions more credible.
Scale what works, but also scale the conditions that make it work
The central mistake in scale-up is to focus on the visible intervention while neglecting the infrastructure underneath it. A referral pathway can be copied. A training program can be repeated. A digital platform can be purchased. None of these automatically reproduces the relationships, community capacity, supervision, leadership, trust, financing and local knowledge that allowed the original pathway to function.
Recent international evidence consistently points in this direction. Global implementation research emphasizes relationships, community capacity and local conditions. Workforce research shows how increasing complexity, burnout and unstable funding can undermine sustainability. Ethnographic work demonstrates how implementation depends on coordinated action across multiple actors and organizational levels. Western Pacific evidence emphasizes adaptation rather than simple transfer.
For Viet Nam, sustainable scale-up should therefore mean more than reaching more people. It should mean increasing reach without losing safety, relational quality, equity, community capacity or the ability to learn.
A useful question before every expansion is:
If we make this pathway larger, can the people, organizations, relationships, resources and governance that make it work grow with it?
If the answer is yes, and the evidence is sufficiently strong for the next stage, expansion may be justified. If the answer remains uncertain, the responsible next step is not necessarily to abandon social prescribing. It may be to strengthen the conditions that are not yet ready.
That is the difference between simply making a pilot bigger and building sustainable community-connected care.
References
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