This post was revised and edited on 1st July 2025.
The Global Climate Risk Index 2021 ranked Vietnam as the thirteenth country in the world most affected by climate variability and extreme weather events between 2000-2019 [1].
The country faces multiple challenges from rising sea levels, changing disease vectors, unpredictable weather patterns, growing population, and male imbalance.
Vietnam joined the Alliance for Transformative Action on Climate and Health in 2023 and committed to become a low carbon and climate resilient health system by 2050 [2].
This post investigated whether Vietnam can pay for sustainable healthcare.
In this post, I ask where Vietnam is right now in its journey to clean, green, resilient healthcare?
Framework
To answer, I’ll make a quick review of publicly available sources, applied against seven criteria of a Living Health Systems framework, adapted from the Living Building Challenge:
- Place
- Beauty & Biophilia
- Universal Healthcare Coverage
- Net+Energy
- Responsible Water
- Responsible Materials
- Regulation & Stewardship
Let’s run through each in turn.
Place
Vietnam is ranked 16th of the world’s most bio-diverse countries and one of the ten richest global centres for biodiversity [3]. A national ecosystem assessment has already identified wide-spread and ongoing loss of biodiversity due to human population growth and increased pressure for water, energy generation, agriculture, manufacturing, and transportation [3].
An important aspect of PLACE is reciprocity with nature. In Vietnam, nature “make(s) substantial contributions to the economy and human welfare…” [4 emphasis added].
There is no mention how humans contribute back to nature.
This is strange because reciprocity is utterly foundational to life in Vietnam. Reciprocity in the form of Contribution+Obligation is seen everywhere. From relationships between the generations, within social networks, formation and strengthening (or loss) of social capital, to the modus-operandi of business and government: nhân đi your action goes out into the world – quả về a result or an obligation is created because of it and returns to you.
So how, then, does the health system contribute to, and fulfill its obligation to, nature? And how can reciprocity be brought clearly into the way that Vietnam will achieve a Net Zero health system by 2050?
Few if any health systems anywhere are thinking like this including Vietnam. But biodiversity and space-for-nature is rising up global political agendas and influencing donors. For instance, Vietnam and Germany signed an agreement in 2023 for EU152million against greenhouse gas reduction, adaptation, and promotion of biodiversity [8]. The health system can be part of this.
As well as reciprocity with nature, Transportation and Food are foundational to place.
Clean transportation and food are included in the Healthcare Without Harm Global Green & Healthy Hospitals program [5]. Vietnam has three members of that program: Hai Phong Medical University Hospital; Health Environment Management Agency; and the Center for Health Environment Research and Development – results of their efforts are not public. Clean food [6] and transport [7] procurement is strengthening in European healthcare organisations and likely to make their way into donor agendas over the mid-term.
Beauty & Biophilia
Biophilia means a love of nature. Beauty in a Living Health System framework is based in nature.
A survey of 229 Vietnamese people from different walks of life, found a common ideal of nature as strongly forest-orientated, with a view that the natural environment is important for health (clean air and water) and future generations and other species (wildlife). The most persistent metaphor across all groups surveyed was a sense of being “In family with nature” (rather than, say, mastery over nature).
Framing nature and ecosystems as an economic ‘service’ is therefore not capturing what is meaningful to Vietnamese – rather the framing should be relational: focusing on care, goodwill, and meaning of nature within the lives of people and communities [9].
Beauty & biophilia are not visible in policy documents, building design standards, health system performance targets or audible in discussion about Vietnam’s sustainability transition. But bringing these values into such discussions could bring urgency and meaning: for Vietnam to get to NetZero in a way that speaks to the heart of what it means to be Vietnamese at this time in history.
Universal Healthcare Coverage
While more money is spent in private sector healthcare, the public sector provides most services: at an estimated 83.4% of all inpatient and 72.1% of all outpatient visits [10]. The rise of unnecessary diagnostics and inappropriate care threatens both quality and sustainability (ecological and financial) of care. Quality of care especially primary care is also influenced by lack of qualified staff in rural hospitals and health centres due to out-migration of staff to urban centres. Several policies are ongoing to address the issues. Nursing levels in particular tend to be lower than doctors, and some health facilities may operate with less-than-required nursing levels [11].
Population healthcare needs especially in rural areas arise from waterborne disease outbreaks during and after heavy rainfall and floods. Dengue fever, malaria, diarrheal diseases, and influenza are all common and rising [12].
In larger cities healthcare needs revolve around the impact of storms, heat waves, and droughts [12]. Vietnam’s population is both growing and ageing with sharply rising burden of non-communicable disease and heavy air pollution is a growing problem. All of these implicate prevention and health promotion services over the professionally-preferred-provision of curative services. Land and water pollution from chemicals and materials waste generating ill health, disability, and mortality is increasingly contentious.
The Social Health Insurance (SHI) covered 93.3% off Vietnam’s population by 2023 with state subsidies for vulnerable groups (registered poor, children under the age of 6). The SHI benefits package is generous including emergency services, medical care (inpatient and outpatient), pharmaceuticals, and expensive therapeutics like organ transplantation and 81 different drugs for cancer [10]. This is one reason why SHI is in deficit.
SHI procurement decisions will be central to greener choices that reduce carbon and other pollutants by the health system as well as reducing unnecessary and inappropriate care. As yet, there is no indication that SHI intends to purchase strategically for a greener health system.
Net+Energy
Electricity can be generated in two main ways: by harnessing the heat made by burning fuels or by capturing the energy from the sun, wind, or moving water.
For the purpose of this post, I assume most of the health system is connected to the electricity grid.
In Vietnam, electricity is generated through [13]:
- 40.2% Coal
- 34.7% Hydro-power
- 10.6% Natural Gas
- 10.3 % Solar
- 3.3% Wind
- 0.9% Biofuels.
Coal is problematic as it clearly contributes to global heating and ever increasing air pollution.
Periodic drought impacts on hydro-power generation, and coal is taking up the slack.
Use of coal for the national grid has increased year-on-year since 2005. Grid infrastructure is extensive in the country, and a minority (about 1% of the population) do not have access according to UNDP Vietnam.
Getting out of coal will be essential for the green transition across all sectors of the economy, not just health.
Responsible Water
There is currently no comprehensive assessment on the quantity of water used by the Vietnamese health system or how water as a resource is managed for human and ecological health. This is not surprising given the diversity of facilities and locations involved (medical, educational, manufacturing and so on).
Some figures are available though.
A study using 2015 data suggested that 72.76% of community health centres had access to improving water and sanitation with better access in the richer communities. Interestingly, rural health centres had higher prevalence of appropriate wastewater treatment [14].
UNICEF Vietnam estimated that about 95% of Vietnam’s population had access to water when they needed it by 2020 but that unsafe water for drinking, hygiene, and medical care was still contributing to spread of infectious diseases such as diarrhoea and growth stunting in children.
WHO stated in 2023 that half of healthcare service delivery sites “cannot rely on the quality or quantity of water they need” [15].
A pilot project [15] completed in 2023 addressed water resilience for health service delivery facilities. The pilot implemented three different place-based strategies:
- For a hospital in the mountainous north, a rainwater-for-drinking system that included catchment, storage, and treatment components was initiated to overcome lack of groundwater.
- A north-central hospital that lacked groundwater and was located on the last-mile for piped water, drew water from a nearby stream via water pipes on neighbouring land. The hospital additionally used a surface water treatment system to assure water quality.
- Last, a hospital in the Mekong Delta, vulnerable to periodic drought, flooding and salination, used an upgraded saltwater filtration system to run 12 hours a day.
Two of these strategies appear (without further details) circular. One strategy (extracting water from local rivers and streams) does not. There was no discussion on storm-water management (hold and slow release of storm waters as well as measures to avoid sheet flow) or wastewater (black/grey) management. Tropical storms are an annual occurrence and increasing in central and northern coastal provinces.
However, the pilots above aimed to contribute to the development of national guidelines focusing on four aspects:
- water, sanitation & hygiene, and health care waste management;
- capacity building & awareness raising;
- energy efficiency & green energy;
- improved infrastructure, technology & products.
This could indicate that policy, at least, will take a more integrated approach to water management in the future.
Responsible Materials
Getting to responsible use of materials across the whole health system implicates the whole economy of supply chain, procurement, and service delivery. The gritty detail of how this can happen emphasises that a health sector is both dependent on the wider economy to produce the materials it needs for healthcare and has the ability to demand clean materials generated through a circular flow and maximize use of locally sourced materials and labour.
The government does have green growth strategies for the wider economy [16] that starts to address these issues:
- A National Green Growth Strategy 2012 updated in 2021
- A National Action Plan for Green Growth 2014 updated in 2021.
The government also committed to a national goal of Net Zero by 2050 at COP26. A National Steering Committee to implement these commitments was established in 2021 [17].
However, Vietnam is weak on solid waste management due to poor reuse, materials recovery and recycling. There is continued use and mixing of hazardous and non-hazardous waste and a lack of waste management infrastructure. The country continues to import scrap waste and is one of the largest generators of ocean and surface water plastic waste. A Vietnam Cleaner Production Center has been established, prompted by concern over the eventual loss of land use in landfills. There are insufficient domestic small and medium enterprises making the move towards circularity in their own operations [18].
From the point of view of healthcare facilities only, a 2020 survey found that waste by volume ranges from 0.8kg – 1kg per hospital bed per day for domestic waste; 0.15kg – 0.25 kg/bed/day for infectious and hazardous waste, and less than 0.1 kg/bed/day for recycled waste.
While there was relatively high compliance by central, provincial, and district hospitals with national regulations for hazardous medical waste treatment, most provincial hospitals spent between $US0.20 – $US0.40/bed/year for waste management. “This is the root cause of ineffective healthcare waste management” [19].
Regulation & Stewardship
In 2022, the Vietnamese Prime Minister approved a National Climate Change Strategy to 2050 which set a goal of reaching net carbon zero by that date [20].
Water, food, and ecosystems security are all included in the strategy as is protection of forest and wetland. Healthcare specific targets are:
- “100% of the population is provided with clean, sanitised water …access to healthcare services”.
- “Develop medical and healthcare …for epidemic and emergent disease control. Ensure environmental sanitation conditions; invest in technology and equipment development for preventing and treating diseases driven by climate change. Build and duplicate community-based healthcare and health models in order to increase community resistance and adaptability to climate change”.
- “Until 2030, focus on strengthening water supply infrastructure system and clean water supply capacity; develop healthcare, medical, and disease control networks prioritising vulnerable subjects and ethnic minority regions; enhance monitoring and early warning systems for impacts of climate change on human health”
Oddly, the strategy doesn’t mention air pollution – air pollution is a clear, present, and ongoing political issue for Vietnamese citizens in big cities.
In the National Adaptation Plan (NAP) 2021-2030 with a vision to 2050, health is mentioned 99 times [21]. A specific program is “enhance resilience and adaptive capacity of natural, economic and social systems, ensure sustainable livelihoods (including) strengthen the medical and healthcare systems”.
The country does not yet appear to have a separate health national adaptation plan, rather the health system is discussed in the National Action Plan.
Notably, a legal basis for protection and management of biodiversity exists. Article 6 of the Biodiversity Law (2008) states that government may assign protection and management of biodiversity to all ministries including the Ministry of Health.
Vietnam joined the Alliance for Transformative Action on Climate & Health (ATACH) in 2023. As yet there is no road-map or action plan for how the Vietnamese health system will achieve this commitment.
Which is not surprising. Only 7% of the ATACH membership had completed such an action plan by December 2024 [24].
And So….
Vietnam currently has legislation, policies, and process that appear to set a destination of Net Zero by 2050.
However, inconsistencies between policies remain. And just as critically, the current bunch of policies will have to be implemented to actually make a change in the country.
Historically Vietnam has not been strong on implementation for two reasons. First, policies tend to be light on detail and not provide a clear guide to action. Second, provincial government is relatively strong on deciding which policies to actually implement. Action is also driven by the demands of organisations involved and their need to maintain trusting relationships with each other over the long term rather than strictly following a policy dictate.
All of this could mean that there is space for charismatic leadership to drive the sustainable healthcare agenda in Vietnam.
References
[1] German Watch (2021) Global Climate Risk Index Who Suffers Most from Extreme Weather Events? Weather-Related Loss Events in 2019 and 2000-2019 https://www.germanwatch.org/en/19777
[2] World Health Organization https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health/commitments
[3] United Nations Development Programme https://www.biofin.org/viet-nam
[4] Biodiversity & Ecosystems Services Network https://www.besnet.world/
[5] Healthcare Without Harm https://greenhospitals.org/goals
[6] North Star Transition https://www.northstartransition.org/insights/localising-nhs-food-sourcing
[7] National Health Service https://www.england.nhs.uk/greenernhs/whats-already-happening/pedal-power-for-cleaner-healthcare-delivery/
[8] VietnamPlus https://en.vietnamplus.vn/germany-signs-agreement-on-oda-for-vietnam-in-2024-2025-period-post271025.vnp
[9] Duong et al (2019) Thinking About Nature in the East: An Empirical Investigation of Visions of Nature in Vietnam Ecopsychology www.doi.org/10.1089/eco.2018.0051
[10] Tran et al (2021) Sustainability and Resilience in the Vietnamese Health System Partnership for Health System Sustainability and Resilience https://www3.weforum.org/docs/WEF_PHSSR_Vietnam_Report.pdf
[11] Hanh et al (2018) Vietnam Climate Change and Health Vulnerability and Adaptation Assessment Environmental Health Insights www.doi.org/10.1177/1178630220924658
[13] International Energy Agency https://www.iea.org/countries/viet-nam/electricity
[14] Huong et al (2018) Water Supply, Sanitation, and Medical Waste Treatment and Disposal at Commune Health Centers in Vietnam Asia Pacific Journal of Public Healthwww.doi/10.1177/1010539518800344
[15] World Health Organization Vietnam https://www.who.int/vietnam/news/detail/12-07-2023-climate-change–viet-nam-secures-hospital-water-supplies-for-resilient-future
[16] OpenDevelopment https://vietnam.opendevelopmentmekong.net/topics/green-growth-in-vietnam/
[17] Nhân Dân https://special.nhandan.vn/lotrinhcop26_en/index.html
[18] Herrador et al (2023). The Unique Case Study of Circular Economy in Vietnam Remarking Recycling Craft Villages Sage Open https://doi.org/10.1177/21582440231199939
[19] Dang et al (2021) Insights of healthcare waste management practices in Vietnam Environmental Science & Pollution Research https://doi.org/10.1007/s11356-020-10832-x
[20] Thư Viện Luật Pháp https://thuvienphapluat.vn/van-ban/EN/Tai-nguyen-Moi-truong/Decision-896-QD-TTg-2022-approving-the-National-strategy-for-climate-change-until-2050/525126/tieng-anh.aspx
[21] United Nations Development Programme https://www.undp.org/sites/g/files/zskgke326/files/2024-02/web_viet_nam_nap_2021-2030_with_vision_to_2050.pdf
[22] ATACH Community of Practice https://www.atachcommunity.com/our-impact/commitment-tracker/atach-baselines/