Transitioning HIV/AIDS Treatment to Local Ownership in Vietnam

A decade ago, Vietnam received over 70% of its funding for HIV/AIDS prevention, treatment, and care from international donors. However, as the country reached middle-income status, donors planned to reduce funding, requiring a significant transition to local ownership and management. The Government of Vietnam (GVN) ultimately decided the country’s social health insurance (SHI) scheme would fund these services, but worried this would be technically and financially unsustainable, while people living with HIV (PLHIV) feared losses in treatment and increased costs.

Utilizing a CLA-focused strategy, USAID helped the Government to operationalize this transition, collaborating closely with a diverse range of local stakeholders to generate and review evidence and learn from experience as the transition took place. USAID’s strategy included four key elements:
 
- Demonstrating SHI’s financial sustainability after the transition with robust evidence & scenario planning.
- Leveraging USAID’s local relationships to build the confidence of PLHIV to enroll into SHI.
- Facilitating outpatient clinic enrollment into SHI to ensure access to services, using data to track progress.
- Working with GVN to develop a centralized procurement system to manage anti-retroviral (ARV) drug purchases more efficiently.

At present, all treatment facilities can now be reimbursed for the bulk of HIV treatment services, and most importantly, SHI funds are now used to procure ARV drugs, the most expensive component of an HIV response. By January 2023, Vietnam had enrolled 90 percent of HIV patients in SHI, and more than 150,000 patients had accessed ARV through the new system. 

This case study was authored by Ritu Singh (USAID), Dr Phan Thi Thu Huong (Vietnam Ministry of Health), Cam Anh Nguyen (USAID/Vietnam) and Sean Mulkerne (Social Impact).