Planning Integrated Long-Term Care Networks for Older People in Viet Nam: Mapping Local Needs, Service Capacity and Referral Pathways
MEASUREMENT, IMPLEMENTATION & LEARNINGINTEGRATED CARE & CARE TRANSITIONS
MEASUREMENT, IMPLEMENTATION & LEARNING · INTEGRATED CARE & CARE TRANSITIONS
Last reviewed: October 2026
A province in Viet Nam wants to improve care and support for its growing older population. It has hospitals, commune-level health stations, social assistance establishments, community organizations and private providers offering different services. Some organizations have supported older people for many years, while others are developing new models of care.
Yet local authorities may struggle to answer several practical questions. How many older people are likely to need continuing assistance with everyday activities? Which services are available near where they live? How many people can those services realistically support? Where are the most important gaps, and who is responsible for connecting different parts of the system?
A locality may have several hospitals but limited continuing care outside healthcare facilities. Another may have active older-person clubs and volunteer networks but few providers capable of supporting people with substantial functional dependency. A residential care facility may have vacant rooms but insufficient staff to support people with more complex needs. Meanwhile, families may be unaware of suitable services or unable to reach them.
These situations illustrate why developing long-term care requires more than increasing the number of facilities.
The central question is: How can local authorities and healthcare organizations in Viet Nam plan integrated long-term care networks that match older people's needs with available services, provider capacity and reliable referral pathways?
Answering this question requires an understanding of the local older population, an accurate picture of existing services and a practical assessment of how different organizations can contribute to a connected network.
A locality should not judge its long-term care system simply by the number of hospitals, residential beds, community clubs or registered providers. It also needs to know whether those services can meet the needs of its population, whether they are accessible and whether important gaps remain between them.
This challenge is especially relevant as Viet Nam implements new policies for older-person care.
Decision No. 1116/QĐ-TTg, issued on June 22, 2026, amended the national Program on Health Care for Older Persons to 2030. The revised objectives include expanding older-person care clubs, volunteer teams, day care models and care facilities developed through socialization.
By 2030, the decision aims for at least 90% of communes, wards and special administrative zones to have at least one older-person care club and one volunteer team participating in older-person care. It also targets at least 20% of these commune-level administrative areas piloting or developing a day care model, and 100% of provinces and centrally governed cities having an older-person care facility developed through socialization.
These are targets for geographical coverage and service development. They do not indicate the proportion of older people receiving care, the number of beneficiaries each service can accommodate or whether the planned services are already operating with adequate capacity and quality.
Meeting these objectives meaningfully will require decisions about where services should be developed, what capabilities they need and how they should connect with existing healthcare and social support resources.
This article examines a proposed Local Integrated Long-Term Care Network Planning and Implementation Framework for Viet Nam.
Its focus is population-level needs, service availability, actual provider capacity, geographical access, gaps in service provision, network connections, governance and implementation readiness.
It does not provide an individual care needs-assessment tool, a clinical referral protocol or a patient-level care coordination pathway. Nor does it establish a new national planning standard or regulatory requirement.
Instead, it considers how local authorities and participating organizations could use available evidence and resources to develop more coherent long-term care networks within their respective legal responsibilities.
From Separate Services to an Integrated Local Network
Older people may require different forms of assistance as their circumstances change.
Some remain independent and benefit mainly from preventive healthcare, social participation and accessible community resources. Others need regular assistance at home, structured daytime support or residential long-term care. Hospital services remain essential when medical assessment or treatment is necessary, but they do not replace continuing personal and social care.
These services are provided by organizations with different responsibilities and capabilities.
A hospital may deliver high-quality medical treatment without operating a home care service. A community organization may support social participation without providing clinical care. A residential provider may assist people with everyday activities while relying on external healthcare professionals for medical treatment.
An integrated network recognizes these differences and helps organizations complement one another.
The World Health Organization's 2021 Framework for Countries to Achieve an Integrated Continuum of Long-Term Care identifies six important system elements: governance, sustainable financing, information, monitoring and evaluation, workforce, service delivery, and innovation and research.
The framework supports countries in assessing how long-term care services can be developed and integrated within existing health and social care systems.
WHO's 2024 Long-Term Care for Older People: Package for Universal Health Coverage offers a complementary perspective. It identifies interventions that countries can consider, prioritize and adapt according to population needs, resources and service delivery arrangements.
The 2024 publication is intended primarily for governments and policymakers responsible for planning and implementing long-term care at national and subnational levels. It is not a clinical guideline for daily practice or a detailed operating manual for individual providers.
WHO Europe's 2024 State of Long-Term Care: Conceptual Framework for Assessment and Continuous Learning in Long-Term Care Systems further emphasizes the relationship between population care needs, system inputs, service outputs, outcomes and population-level impact.
These publications provide useful foundations for assessing care systems, identifying gaps and making informed decisions about service development.
A locality should understand what its older population needs and what its existing services can actually deliver before deciding where additional capacity is necessary.
An integrated network does not require every provider to belong to one organization, use identical contracts or operate through a single information system. It does, however, require a shared understanding of available services, clearly defined responsibilities and workable connections between providers.
The goal is not simply to create more services. It is to develop a local system in which those services can function together.
The 2026 Policy Context for Long-Term Care in Viet Nam
Viet Nam's policy framework provides several foundations for strengthening care and support for older people.
The Law on the Elderly No. 39/2009/QH12 establishes important rights and responsibilities concerning older-person care.
Decision No. 383/QĐ-TTg, issued on February 21, 2025, approved the National Strategy on Older Persons to 2035, with a Vision to 2045. The strategy provides broader directions for improving older people's health, welfare, social participation and access to appropriate support.
A particularly relevant development is the Law on Population No. 113/2025/QH15, which took effect on July 1, 2026.
Article 18 recognizes different forms of older-person care, including self-care, home-based care, community-based care and care provided through appropriate older-person care establishments and healthcare facilities.
The law also addresses measures to support family caregivers and the development of volunteer networks, clubs and self-help groups.
Decree No. 168/2026/NĐ-CP, issued on May 15, 2026 and effective July 1, 2026, provides further provisions concerning older-person care at home and in the community.
Article 7 specifically addresses community-based day care points for older people.
Under the conditions established by that article, the chairperson of the commune-level People's Committee decides on establishing a community day care point under the commune-level health station, based on a proposal from the health station and consideration of local needs, personnel, premises and safety.
The decree identifies this as a specific daytime community care arrangement. Under its provisions, the point does not have separate legal personality and does not conduct medical examination and treatment activities. It may operate at an appropriate existing local venue rather than necessarily within the physical premises of the health station.
This arrangement should not automatically be treated as equivalent to an overnight residential facility, a private day care business or a licensed medical examination and treatment establishment.
The Ministry of Health's Decision No. 1976/QĐ-BYT, issued on July 1, 2026, provides professional guidance on older-person care at home and in the community.
The guidance is relevant when examining the activities, personnel and practical arrangements of community-based care models. However, it should not be interpreted as granting participating individuals or organizations independent authority to undertake regulated medical examination and treatment beyond their lawful scope.
Decision No. 1116/QĐ-TTg establishes additional national implementation targets, including the development of day care models and older-person care facilities through socialization.
An important distinction is that the national target for day care models should not automatically be equated with the specific community day care point established under Article 7 of Decree No. 168/2026/NĐ-CP.
Different day care arrangements may have different legal forms, service scopes, staffing and operating requirements. These differences need to be examined before services are classified or counted as equivalent capacity.
Similarly, establishing a care facility through socialization does not, by itself, demonstrate that the facility provides publicly financed care, accepts every level of dependency or has achieved a particular quality certification.
The revised national program also sets a target for every province and centrally governed city to have a geriatric hospital or a general hospital with a geriatric specialty by 2030. This is relevant to planning healthcare capacity for older people, but it should not be confused with the availability of long-term social and personal care services.
For local network planning, policy targets provide direction. The actual availability, capability and connections of services still need to be verified.
Planning Within Viet Nam's Two-Tier Local Government Structure
A significant consideration for local network planning is Viet Nam's current administrative structure.
The Law on Organization of Local Government No. 72/2025/QH15, effective from June 16, 2025, establishes a two-tier system of local government comprising provincial-level and commune-level administration.
Commune-level administrative units include communes, wards and special administrative zones.
This affects how local service networks should be planned and governed.
A network may cover several neighboring communes or wards because they share hospitals, transportation routes or service providers. However, that geographical service area does not automatically constitute a separate administrative authority.
A term such as district-level service catchment may still have geographical meaning in certain analyses, but it should not imply the continuing existence of the former district-level local government structure.
Network planning should therefore distinguish the geographical area being served from the authority legally responsible for decisions.
Provincial and commune-level authorities have responsibilities determined by current legislation and applicable decentralization, delegation and sector-specific arrangements.
A collaboration covering several communes may require provincial-level coordination or another lawful mechanism.
Likewise, a commune-level initiative cannot assume authority over hospital operations, regulated services or public expenditure outside its legal competence.
The practical starting point is to identify which decisions need to be made and which organizations are legally authorized to make them.
This distinction is especially important when a proposed network involves healthcare, social assistance and private care providers operating under different legal frameworks.
A geographical service network may cross administrative boundaries. Its planning arrangements should reflect how people actually access services, while its governance must respect the applicable distribution of legal responsibilities.
Defining the Local Population and Service Catchment
The first planning decision is to define the geographical area and population that the proposed network will serve.
A provincial exercise may examine long-term care across an entire province or centrally governed city. A smaller exercise may focus on several neighboring communes or wards that share important healthcare and social support resources.
The appropriate area depends on the planning purpose.
Some community activities are most accessible when organized near where older people live. Other services, such as specialized residential care or more complex healthcare support, may require a larger population to sustain the necessary workforce and infrastructure.
Network planning should not assume that every type of service must exist in every commune.
Instead, it should determine which services need to be locally available and which can reasonably serve a wider area without creating unacceptable barriers.
Population distribution, travel conditions, provider capacity and transportation availability all influence this decision.
The analysis should begin with available demographic information, including the number and geographical distribution of older residents.
However, age alone cannot determine how much long-term care a population needs.
Two localities with similar numbers of older people may face very different demands because of differences in functional limitations, disability, household composition, financial circumstances and available family support.
A meaningful population profile should therefore describe more than the number of residents above a particular age threshold.
It should help estimate where different forms and levels of continuing assistance are likely to be needed.
The planning area should also reflect actual service use. Older residents may obtain medical care, residential support or other services outside their commune or province, while providers within the locality may serve people from surrounding areas.
Ignoring these movements can lead to inaccurate estimates of available capacity and unmet demand.
A local network should therefore be understood as a practical service catchment, not necessarily a closed geographical system.
This remains a population-level planning exercise. It does not replace an individual assessment when an older person seeks or receives a particular service.
Estimating Population-Level Long-Term Care Needs
Local planners need a reasonable estimate of how many older people may require different forms of assistance.
Potential information sources include population statistics, relevant health and disability surveys, authorized social assistance data, existing community assessments and information about service utilization.
Hospital and primary care data may provide additional context. However, medical diagnoses alone are insufficient to establish long-term care dependency.
An older person with several chronic conditions may remain independent in everyday activities. Another person with relatively few documented diagnoses may require substantial assistance because of functional limitations.
For network planning, the relevant question is how support needs are distributed across the population.
Where reliable information is available, planners may examine limitations in everyday activities, mobility, cognition and other aspects of functioning.
Household circumstances also matter.
Older people living alone or in households with limited caregiving capacity may face greater difficulties obtaining practical support. Yet living alone does not automatically mean that a person requires residential care, just as living with relatives does not guarantee that adequate assistance is available.
Such assumptions can distort estimates of demand and lead to inappropriate service development.
Where existing information is incomplete, a carefully designed community survey or sampling exercise may be appropriate.
The objective should be to produce sufficiently reliable estimates for planning, not to collect excessive personal or clinical information.
Sampling methods, data definitions and limitations should be documented. Findings from a small or unrepresentative sample should not be presented as precise estimates for an entire locality.
Where uncertainty is substantial, a plausible range of demand may be more useful than a single number reported with unjustified precision.
Planners should also distinguish observed service utilization from underlying need.
Low use of home-based care may reflect limited availability, cost, poor public awareness or geographical barriers rather than low demand.
Similarly, frequent hospital use does not automatically demonstrate that more residential long-term care places are required.
For planning toward 2030, localities may also benefit from examining how demand could change over time.
This does not require an elaborate forecasting model in every locality. A practical approach may compare current estimates with alternative scenarios reflecting population aging, changing household circumstances and different assumptions about service uptake.
The assumptions should be explicit. Projected demand should not be presented as a confirmed future number.
Population estimates should guide planning while recognizing that service choices must also reflect preferences, available resources and the actual capabilities of local providers.
Mapping the Services That Already Exist
Once the planning area and population have been defined, the next task is to identify the services already available.
A meaningful inventory should include more than organizations formally described as long-term care providers.
Depending on local conditions, relevant services may include commune-level health stations, hospitals, rehabilitation providers, social assistance establishments, residential care facilities, home-based care organizations, community day care points, older-person clubs, volunteer networks and other organizations providing lawful support.
These organizations operate under different legal and professional arrangements.
A hospital provides medical examination and treatment under the applicable healthcare framework. A social assistance establishment has a different mandate. A community club may support social participation and practical activities without being authorized to deliver clinical care.
Private organizations may offer different combinations of personal assistance, residential accommodation and healthcare-related services, subject to the legal requirements applicable to their activities.
The inventory should therefore classify services according to what providers are authorized and capable of delivering, rather than simply by their organizational names.
An organization may contribute to more than one part of the network.
For example, a residential facility may provide accommodation, meals and personal assistance while arranging medical consultations through a separate healthcare provider.
These functions should be distinguished.
The facility's ability to arrange medical consultations does not establish that it independently delivers every healthcare service used by its residents.
Similarly, an older-person club may contribute to social participation without having the personnel or operating arrangements necessary to support individuals with substantial dependency.
A useful inventory should record the actual functions of each service, its geographical coverage, relevant operating arrangements, access conditions and important limitations.
It should also distinguish services currently operating from those that have merely been proposed, approved or announced.
A facility under development should not be counted as existing operational capacity. A service that operates intermittently should not be described as continuously available.
The objective is to understand how the local network operates in practice, rather than how services appear in promotional materials or administrative lists.
Assessing Effective Provider Capacity
Knowing that a service exists does not establish how many people it can support or what level of assistance it can provide.
A residential facility may have vacant accommodation but insufficient staff to care for people requiring extensive daily assistance.
A community day care point may have premises and scheduled activities but limited capacity to support participants with substantial mobility or personal care needs.
A home-based care provider may advertise services across a wide geographical area while having staff available in only a small part of that area.
Network planning should therefore distinguish nominal capacity from effective service capacity.
Physical capacity concerns premises, accommodation, accessible spaces and equipment.
Workforce capacity concerns the number, competencies, supervision and availability of people required to deliver services.
Operational capacity concerns whether services can function reliably during their stated hours and manage ordinary fluctuations in demand.
Professional and legal capacity concerns the activities an organization may lawfully undertake.
Effective capacity depends on these factors working together.
A residential bed should not automatically be counted as an available place for someone with substantial dependency. A community activity space should not be treated as equivalent to a place providing continuous personal assistance.
Likewise, employing a person with healthcare qualifications does not independently establish that an organization is authorized to deliver every medical service associated with those qualifications.
Planners should seek information about what assistance providers can actually offer, the populations they are able to serve and whether they can accept additional beneficiaries.
Capacity information should distinguish between total places, currently occupied places and capacity genuinely available for new service users.
Different service models may also require different units of measurement.
For residential care, available places may be relevant when considered alongside staffing and service capabilities.
For home-based assistance, the practical capacity may be better represented by available service hours, personnel and travel coverage.
For community day care, the number of participants who can be safely supported during actual operating sessions may be more meaningful than the physical size of the premises.
These measures should not be added together as though they represented interchangeable long-term care places.
Where possible, providers should describe their services using consistent definitions.
This does not mean imposing identical staffing or operating arrangements on different types of organizations. It means ensuring that the capacities being compared represent genuinely comparable services.
The purpose is not to rank facilities by size. It is to establish a realistic picture of what the local network can deliver.
Identifying Gaps Between Needs and Available Services
The main value of combining population information with provider capacity is the ability to identify unmet service needs.
A service gap exists when a relevant need cannot be met through available providers under realistic conditions.
The problem may be the absence of a service, insufficient capacity, limited professional scope, poor geographical access or financial barriers.
For example, a locality may have several hospitals and residential facilities but little dependable assistance for older people who need help with everyday activities while remaining at home.
Another may have an active volunteer network but few services capable of supporting people whose dependency exceeds what volunteers can appropriately provide.
A third may have formal services concentrated in urban areas while older residents in remote communities face substantial difficulties reaching them.
These problems require different responses.
Building another residential facility may do little to address a shortage of home-based assistance. Expanding community activities may not meet the needs of people requiring extensive personal support or overnight care.
Similarly, adding new providers may not improve access if existing organizations are poorly connected and families cannot identify suitable services.
Planners should therefore distinguish capacity gaps from coordination gaps.
A capacity gap may require additional workforce, equipment, service hours or a new provider.
A coordination gap may be addressed through better service information, clearer contact points or improved connections between organizations that already exist.
Some localities will experience both.
There may also be an affordability gap when services exist but remain financially inaccessible to a substantial portion of the population needing them.
This should be identified separately from a complete absence of service capacity, because the potential policy responses differ.
A credible gap analysis should also consider the intensity of support required.
Having sufficient services for relatively independent older people does not establish adequate coverage for those with substantial functional limitations.
These distinctions can prevent unnecessary investment in new infrastructure when the more immediate problem is poor organization or accessibility.
They can also prevent the opposite mistake: assuming that better coordination alone will resolve a genuine shortage of services.
A network plan should identify which gaps require additional capacity, which require better connections and which involve barriers to practical access.
Geographical Access Must Reflect Real Conditions
A service may appear accessible on a map but be difficult for older people to reach in practice.
Straight-line distance does not necessarily reflect travel time or the effort required to use a service.
Road conditions, transportation availability, physical accessibility, travel costs and the need for assistance can all influence access.
Urban and rural areas may face different barriers.
In densely populated communities, services may be nearby but difficult to reach because of congestion, limited accessibility or financial constraints.
In rural and remote areas, older people may face longer journeys, fewer service choices and shortages of appropriately trained personnel.
The geographical coverage advertised by a provider may also differ from the area it can reliably serve.
A home care organization may describe province-wide coverage while having limited staff availability outside certain locations.
Local mapping should therefore consider actual service reach rather than administrative coverage alone.
Where suitable data are available, planners can examine travel times, transportation options and the geographical distribution of older people likely to need more intensive assistance.
However, maps should not imply greater precision than the underlying information supports.
A calculated travel time has limited practical meaning if a provider has no available places or cannot meet the person's care needs.
Similarly, an area may appear adequately served because several providers are located nearby, even though their operating hours, eligibility conditions or service capabilities exclude many potential users.
Geographical accessibility must therefore be interpreted alongside service capacity, suitability and affordability.
The objective is to identify communities with limited practical access and determine which service arrangements could improve that situation.
Connecting Healthcare, Community Support and Long-Term Care
After identifying local services and gaps, planners need to determine how different parts of the network can connect.
An older person may use primary healthcare, hospital services, home-based assistance, community activities and residential care at different times.
The network should make these services easier to understand and navigate without assuming that one organization is responsible for every aspect of care.
A commune-level health station may provide a point of contact for authorized community healthcare and older-person care activities.
Hospitals may identify continuing support needs that cannot be met through hospital treatment alone.
Social assistance establishments may provide services to eligible beneficiaries within their statutory responsibilities.
Residential long-term care providers may support people who require continuing assistance beyond what is available in their previous living arrangements.
Community organizations may contribute to social participation, practical support and connection.
These are potential roles rather than universal assignments.
Their actual application depends on the services available locally and the legal authority of each organization.
A network should not treat community organizations as informal extensions of hospitals or assume that social care providers can perform regulated clinical activities outside their scope.
Instead, planning should identify where services complement one another and what connections are needed between them.
The network should also consider situations in which a particular provider cannot meet a need.
If a service is full or lacks the required capability, participating organizations should have access to reliable information about other appropriate options where they exist.
This is a network-level service navigation issue. It is different from defining the clinical decisions and responsibilities involved in an individual care episode.
The planning objective is to reduce unnecessary gaps and confusion between services.
A connected network should make appropriate options more visible, while recognizing that service eligibility, clinical suitability and provider acceptance still need to be determined through the relevant processes.
Service Navigation Is Not the Same as Medical Referral
The term referral pathway is widely used in integrated care, but it has different meanings depending on the context.
In long-term care network planning, a referral pathway may describe an agreed arrangement through which an older person or family can obtain information about an appropriate service and understand how to access it.
A community organization may provide information about available home-based assistance. A residential provider may identify an authorized healthcare organization offering relevant services.
These arrangements involve service navigation, communication and coordination.
They are not necessarily formal patient transfer procedures under medical examination and treatment law.
Viet Nam's Law on Medical Examination and Treatment No. 15/2023/QH15 regulates relevant aspects of patient transfers between medical examination and treatment establishments.
Health insurance legislation, including amendments introduced by Law No. 51/2024/QH15 and applicable implementing instruments such as Circular No. 01/2025/TT-BYT, provides separate requirements concerning insured healthcare access, transfers between healthcare establishments and payment.
These legal arrangements have specific purposes, procedures and conditions.
A local long-term care network agreement cannot replace regulated medical transfer procedures, establish new clinical referral rights or change the conditions for health insurance reimbursement.
Similarly, identifying a residential or community provider as part of an integrated network does not automatically create a publicly financed entitlement to use its services.
A service directory may explain where services are available. It does not itself establish legal eligibility, clinical suitability or payment coverage.
For Viet Nam, a network plan should therefore distinguish service navigation pathways from regulated medical referral and patient transfer procedures.
The first helps people understand and access appropriate support across the local service system. The second must comply with the applicable healthcare and health insurance framework.
This distinction should be reflected in network documents and communication materials.
A general recommendation to contact another service should not be presented as an official medical referral document. Equally, inclusion in a community service network should not be interpreted as authorization to deliver medical care.
Maintaining these boundaries is essential for accurate public information and responsible network governance.
Assigning Responsibility for Network Coordination
A functioning service network needs an arrangement for planning, maintaining information and reviewing progress.
This does not necessarily require creating a new agency or administrative authority.
Under Viet Nam's two-tier local government structure, provincial and commune-level authorities have responsibilities defined by current legislation and applicable decentralization arrangements.
A network covering several communes may require provincial-level coordination or another lawful mechanism connecting participating organizations.
Responsibilities should be identified according to the decisions involved.
Establishing or authorizing a particular service may fall under one legal framework, while operating a licensed healthcare establishment falls under another.
Maintaining a service directory or convening discussions between providers does not confer authority to regulate their professional activities.
A coordination group can be useful when it brings together organizations with relevant responsibilities and practical knowledge.
Its work may include reviewing service availability, identifying gaps, maintaining agreed information and considering implementation priorities.
However, participation in a network does not automatically transfer legal, financial or professional responsibilities from one organization to another.
A hospital remains accountable for its healthcare activities. A social assistance establishment remains subject to its applicable operating requirements. Community organizations and private providers remain responsible for their own lawful services.
The network should make these responsibilities explicit.
It should also establish who maintains provider information, how changes are reported and how significant unresolved gaps are communicated to the appropriate authority.
A practical governance arrangement should identify responsibility for maintaining the network's shared information and organizing periodic reviews.
It should also recognize that different decisions may require approval from different authorities or organizations.
Without someone responsible for maintaining it, even a well-designed service map can become outdated quickly.
Developing a Trustworthy Local Service Directory
A verified local service directory can be one of the most useful early outputs of network planning.
It allows participating organizations to understand what services exist and helps identify appropriate alternatives when a particular provider cannot meet a need.
A useful directory should contain more than organizational names and contact details.
It should describe the type of service, geographical coverage, access conditions, operating arrangements and relevant limitations.
Where appropriate, it may indicate whether the organization provides home-based assistance, community support, residential care or authorized medical services.
Providers should have a way to update information when their service scope, availability or operating arrangements change.
The directory should distinguish information verified through appropriate records or procedures from claims supplied by providers that have not been independently assessed.
This is particularly important when describing regulated healthcare services.
A residential provider should not be presented as independently offering medical examination or treatment unless its authorization and actual service arrangements support that description.
Likewise, inclusion in a directory should not imply government endorsement, accreditation or certification by Healthy Longevity Vietnam.
A directory is a planning and navigation resource, not a substitute for regulatory assessment or professional quality assurance.
Its credibility depends on accurate descriptions, transparency about verification and regular updates.
A useful approach is to record when provider information was last confirmed and identify the organization responsible for reporting changes.
Where capacity information has not been recently verified, the directory should not imply that services or places are immediately available.
The purpose is to provide reliable information about the local care landscape without creating an inaccurate impression of guaranteed access or quality.
Using Population and Provider Data Responsibly
Local network planning depends on information from different organizations.
Some information, such as aggregate population statistics and the locations of public services, may be available through official or otherwise authorized sources.
Other information, including individual health records, disability status or social assistance records, may contain sensitive personal data.
The fact that information could improve planning does not automatically authorize unrestricted collection or sharing.
Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements concerning personal data processing.
Organizations should determine the appropriate legal basis, purpose, scope and safeguards before collecting or sharing identifiable information.
For population-level planning, aggregated information may often be sufficient.
A locality may need to estimate how many older residents in different areas require regular assistance without collecting their names, detailed diagnoses or addresses.
Where data are de-identified, planners should still consider whether individuals could reasonably be identified, particularly in small populations or through combinations of datasets.
Data protection is not the only concern. Information quality and comparability also matter.
Organizations may use different definitions of dependency, disability, long-term care or service utilization.
Combining these records without examining their definitions can produce misleading conclusions.
Planners should document where information came from, when it was collected, what it measures and which limitations affect its interpretation.
A map based on incomplete provider lists should not be described as a comprehensive assessment of local service availability. Similarly, service utilization data should not be treated as a complete measure of unmet need.
Where planning relies on estimates, the assumptions and level of uncertainty should be made clear.
Being transparent about uncertainty makes the planning process more credible and helps identify where better information is required.
Prioritizing Development When Resources Are Limited
Most localities will not be able to address every identified service gap at once.
A realistic plan must therefore establish priorities.
The seriousness of unmet needs, the number of people affected, existing inequalities and the feasibility of proposed solutions should all be considered.
A high-priority gap is not always the one involving the largest number of people.
A smaller population in a remote area may have very limited access to essential services and face greater practical disadvantages than a larger population with several existing options.
Planners should distinguish between interventions that add genuinely needed capacity and those that duplicate services already available.
For example, an area with active community clubs but insufficient home-based assistance may benefit more from developing appropriate support for everyday activities than from establishing another club.
A locality with residential care places but weak connections to healthcare providers may need better service coordination rather than another residential building.
These conclusions should come from verified local information, not assumptions.
Workforce availability and operational sustainability also matter.
A proposed service may be attractive but unrealistic if the locality cannot recruit suitable personnel or maintain the necessary resources.
Local planners should also consider whether a proposed investment will address the underlying problem.
A shortage of accessible transport may require a different response from a shortage of care workers. Inadequate information about available services may be improved without constructing additional facilities.
Financial feasibility should therefore be considered, while recognizing that network planning is not the same as designing a comprehensive long-term care financing system.
Detailed public benefit eligibility, subsidies and purchasing arrangements require separate legal and financial assessment.
The role of network planning is to establish which service capacities are needed and whether proposed development options can realistically contribute to meeting those needs.
Assessing Readiness Before Expanding the Network
A service network may look coherent in a planning document but remain difficult to implement.
Readiness should therefore be assessed before significant expansion.
Governance readiness concerns whether the responsible authorities and participating organizations understand their roles and can make the decisions necessary to implement the plan.
Service readiness concerns whether providers have the lawful scope, personnel, premises, equipment and operating arrangements required for their proposed activities.
Connection readiness concerns whether organizations know how to communicate and whether appropriate service navigation arrangements can function across different services.
Information readiness concerns the accuracy of population estimates, provider descriptions and capacity information.
Sustainability concerns whether the proposed services and coordination arrangements can continue beyond their initial launch.
For example, a community activity may begin successfully but prove difficult to maintain if it depends entirely on temporary volunteers or short-term funding.
A service directory may initially be accurate but become unreliable if nobody is responsible for updating it.
A collaboration may work while particular individuals are available but fail when those people change roles.
Readiness assessment should identify these limitations before the network depends on the proposed arrangements.
It should not simply classify localities as successful or unsuccessful.
Some areas may be ready to expand an existing service. Others may first need better population information, workforce development, clarified responsibilities or more dependable connections.
Implementation should also distinguish immediate improvements from changes requiring longer preparation.
Updating provider information or establishing communication arrangements may be feasible relatively quickly. Developing a new residential service, recruiting a qualified workforce or establishing a lawful public financing mechanism may require substantially more preparation.
The appropriate implementation sequence depends on the evidence and the authority and resources available to the participating organizations.
A Practical Local Integrated Long-Term Care Network Planning Framework
For Viet Nam, the planning process can be organized into a proposed Local Integrated Long-Term Care Network Planning and Implementation Framework.
The framework begins with a Local Older-Person Population and Needs Profile.
This describes the distribution of older residents, available indicators of functional limitations, household circumstances and likely demand for different forms of continuing support. It should distinguish observed data from estimates and explain important uncertainties.
The second component is a Local Service and Provider Capacity Map.
This records existing services, their locations, legal and professional scope, relevant workforce and operating arrangements, and the level of support they can realistically provide. It distinguishes nominal capacity from effective capacity.
A Service Access and Gap Analysis then compares estimated population needs with available services. It identifies missing capacity, geographical barriers, limited service availability and areas where existing organizations are insufficiently connected.
The fourth component is a Network Connection and Service Navigation Matrix.
This describes how participating organizations relate to one another, what types of services may be accessed through each provider and where formal medical referral or transfer requirements must be followed.
It should not be mistaken for a clinical pathway governing individual patient care.
The fifth component is a Governance and Responsibility Map.
This identifies the relevant authorities and organizations responsible for planning decisions, service information, coordination and review, while respecting the current administrative structure and legal boundaries.
Finally, a Network Readiness and Improvement Review examines whether the proposed arrangements are practical, whether participating providers are prepared and whether the network can maintain reliable information and respond to emerging gaps.
These six components are proposed planning and quality improvement tools.
They are not nationally mandated Vietnamese templates, new legal classifications or an accreditation framework.
Their value is that they connect population needs, provider capabilities, geographical access and implementation decisions within one process.
A locality should not decide to build additional residential capacity without understanding existing service gaps. It should not rely on a provider directory without checking the services described. Nor should it establish referral arrangements without clarifying which activities require separate legal authorization.
The framework brings these considerations together in a practical planning approach.
It can be adapted to different planning areas, levels of administrative responsibility and stages of local service development.
Beginning With a Manageable Local Planning Exercise
A locality does not need to begin by mapping every possible care service across an entire province.
A more practical starting point may be a limited geographical area and a defined set of relevant services.
For example, an appropriately authorized provincial initiative could examine long-term care availability across several neighboring communes or wards.
The exercise could draw on existing demographic information, a verified provider inventory, relevant administrative data and discussions with participating organizations.
Older people and family caregivers may provide valuable perspectives on accessibility, service awareness and unmet needs.
However, consultation findings should not be presented as statistically representative population estimates unless the research design supports that interpretation.
The first output should be a credible picture of local needs and existing service capacity.
Participating organizations can then examine which gaps are most important and what type of response is appropriate.
They may find that a particular service is missing. Alternatively, they may discover that existing providers are difficult to identify or poorly connected.
These findings should lead to different implementation decisions.
A locality might improve its service directory, strengthen communication between authorized providers, address geographical access barriers or develop additional service capacity where justified.
Any proposal to establish a new facility, introduce regulated services or allocate public resources must follow the applicable legal and administrative procedures.
An initial pilot should test whether the proposed network arrangements work in practice.
This might begin with improving the accuracy of provider information, testing service navigation arrangements or assessing how available capacity matches demand across a defined local area.
The objective is not simply to complete a planning document, but to determine whether people and organizations can make better use of the services available.
The findings should inform revisions before the approach is expanded.
Measuring Whether the Local Network Is Improving
A network should be evaluated according to what it was intended to achieve.
If the objective is to improve service availability, the evaluation should examine whether the relevant population has gained more realistic access to appropriate support.
If the objective is to address geographical gaps, it should consider whether previously underserved areas have more suitable options.
If the objective is to strengthen connections, it should assess whether participating organizations have accurate service information and functional navigation arrangements.
Useful measures may include verified service capacity, geographical coverage, practical availability, unmet demand and the completeness and currency of provider information.
It may also be useful to examine whether organizations can identify appropriate alternatives when their own capacity is insufficient.
These indicators require careful interpretation.
An increase in service use may reflect improved access, but it may also result from changing demand or greater awareness.
An increase in residential beds may not help older people who primarily need assistance at home.
A larger provider directory may create the appearance of a more developed network without increasing the workforce or actual service capacity available.
Evaluation should therefore focus on meaningful access and effective capacity rather than activity alone.
WHO Europe's 2024 State of Long-Term Care framework provides a useful conceptual approach by connecting population needs with system inputs, outputs, outcomes and longer-term impact.
For a local network, this means distinguishing the resources available from the services actually delivered and the access improvements achieved.
For example, opening a new community care point is an implementation output. Whether it can serve the intended population and reduce a documented access gap is a separate question.
The number of participating organizations is similarly different from the reliability of connections between them.
Quality considerations remain relevant.
A provider operating outside its lawful scope or lacking essential resources should not be treated as an adequate solution merely because it appears on a service map.
However, network-level evaluation should not become a substitute for provider licensing, clinical quality measurement or accreditation.
Its role is to determine whether the local configuration of services is becoming more accessible, appropriate and dependable.
A limited set of reliable indicators will generally be more useful than an elaborate reporting system that participating organizations cannot sustain.
Connecting National Objectives With Local Implementation
Viet Nam's current policy environment provides an opportunity to move from broad objectives for older-person care toward more coordinated local service development.
Decision No. 1116/QĐ-TTg establishes national targets for older-person care clubs, volunteer teams, day care models and facilities developed through socialization.
Decree No. 168/2026/NĐ-CP and the Ministry of Health's Decision No. 1976/QĐ-BYT provide more specific provisions and professional guidance relevant to certain forms of home-based and community-based care.
The National Strategy on Older Persons to 2035 provides a broader direction for improving care and support.
These instruments do not remove the need for local planning.
National targets cannot determine exactly how many people a particular community day care point can support, where a residential provider should operate or whether a locality has sufficient trained workers.
Those decisions require local evidence.
Ho Chi Minh City provides a recent example of system-level planning.
On October 8, 2026, the Ho Chi Minh City People's Committee issued Decision No. 6655/QĐ-UBND, approving the proposal to develop an older-person healthcare system adapted to population aging for 2026–2030, with a vision to 2045.
The proposal describes a five-level system covering self-care and health promotion, community support, home-based support, residential care and hospital services.
It also identifies local development objectives, including expanding community day care points and other services.
This is an important policy direction for Ho Chi Minh City, but it should not be interpreted as evidence that every planned service is already operating or that the city's model is a mandatory national structure.
The proposed system will still require decisions about geographical coverage, workforce, provider capability, access and coordination.
This illustrates the wider challenge facing localities across Viet Nam.
National and local policies can identify the direction of development. Effective network planning determines which services are needed, where they should operate, how they should connect and whether the necessary resources and responsibilities are in place.
From More Facilities to a Better Connected System
Viet Nam's aging population will increase demand for different forms of continuing care and support.
Responding to that demand will require appropriate service development. However, the number of facilities alone is not an adequate measure of progress.
A locality may have hospitals, community organizations, care providers and social assistance establishments without having a dependable long-term care network.
The missing element may be an understanding of population needs, a realistic picture of provider capabilities or practical connections between services.
Local integrated long-term care network planning begins by making these relationships visible.
It examines where older people live, what forms of support may be required, which services are available, who can realistically access them and where the important gaps remain.
It also requires clear distinctions.
A service directory is not an accreditation scheme. A community navigation pathway is not the same as a regulated medical transfer. A national target to expand services does not prove that those services are already available or adequately staffed. A network planning proposal does not automatically create new public funding or regulatory authority.
Maintaining these distinctions is essential for responsible implementation.
A strong local long-term care network is not defined by how many services appear on a map. It is defined by whether appropriate services are available, accessible, capable and sufficiently connected to meet the needs of the older population.
For Viet Nam, a Local Integrated Long-Term Care Network Planning and Implementation Framework could help authorities and participating organizations connect population-level needs with actual service capacity, identify development priorities and strengthen connections between healthcare, community support and long-term care.
The objective is not to create one identical model for every locality.
It is to support service networks that reflect local needs and resources while maintaining clear legal responsibilities, appropriate professional boundaries and reliable access to care.
As Viet Nam implements its newer policies for older people, the ability to plan and improve these networks will become an increasingly important part of building integrated, age-friendly and sustainable long-term care.
References
National Assembly of Viet Nam. Law on the Elderly No. 39/2009/QH12. Adopted November 23, 2009; effective July 1, 2010, as amended.
Government of Viet Nam. Decree No. 06/2011/NĐ-CP Detailing and Guiding the Implementation of Certain Provisions of the Law on the Elderly. January 14, 2011, as applicable and amended.
Prime Minister of Viet Nam. Decision No. 1579/QĐ-TTg Approving the Program on Health Care for Older Persons to 2030. October 13, 2020, as amended.
National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted January 9, 2023; principally effective January 1, 2024, as amended.
Government of Viet Nam. Decree No. 96/2023/NĐ-CP Detailing Certain Provisions of the Law on Medical Examination and Treatment. December 30, 2023, as applicable and amended.
National Assembly of Viet Nam. Law No. 51/2024/QH15 Amending and Supplementing Certain Provisions of the Law on Health Insurance. Adopted November 27, 2024; principally effective July 1, 2025.
Ministry of Health of Viet Nam. Circular No. 01/2025/TT-BYT Detailing and Guiding the Implementation of Certain Provisions of the Law on Health Insurance. January 1, 2025, as applicable and amended.
Prime Minister of Viet Nam. Decision No. 383/QĐ-TTg Approving the National Strategy on Older Persons to 2035, with a Vision to 2045. February 21, 2025.
National Assembly of Viet Nam. Law on Organization of Local Government No. 72/2025/QH15. Adopted and effective June 16, 2025.
National Assembly of Viet Nam. Law on Population No. 113/2025/QH15. Adopted December 10, 2025; effective July 1, 2026.
National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted June 26, 2025; effective January 1, 2026.
Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Provisions and Measures for Implementing the Law on Personal Data Protection. December 31, 2025; effective January 1, 2026.
Government of Viet Nam. Decree No. 168/2026/NĐ-CP Detailing Certain Provisions and Measures for Implementing the Law on Population. May 15, 2026; effective July 1, 2026.
Prime Minister of Viet Nam. Decision No. 1116/QĐ-TTg Amending and Supplementing Decision No. 1579/QĐ-TTg on the Program on Health Care for Older Persons to 2030. June 22, 2026.
Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT Issuing Professional Guidance on Older-Person Care at Home and in the Community. July 1, 2026.
Ho Chi Minh City People's Committee. Decision No. 6655/QĐ-UBND Approving the Proposal for Development of an Older-Person Healthcare System Adapted to Population Aging in Ho Chi Minh City, 2026–2030, with a Vision to 2045. October 8, 2026.
World Health Organization. Framework for Countries to Achieve an Integrated Continuum of Long-Term Care. Geneva: World Health Organization; 2021. ISBN: 9789240038844.
World Health Organization. Long-Term Care for Older People: Package for Universal Health Coverage. Geneva: World Health Organization; 2024. ISBN: 9789240086555.
World Health Organization Regional Office for Europe. State of Long-Term Care: Conceptual Framework for Assessment and Continuous Learning in Long-Term Care Systems. Copenhagen: WHO Regional Office for Europe; 2024. WHO Reference Number: WHO/EURO:2024-10363-50135-75508.