Social Contracting Model in HIV Service Delivery in Vietnam: Opportunities and Challenges

The social contracting model in HIV service delivery in Vietnam is emerging as a key solution, particularly in the context of declining international aid. This model not only offers opportunities to sustain HIV prevention and treatment services, but also plays a crucial role in building a long-term, resilient healthcare system. However, for this model to reach its full potential, Vietnam must address a range of ongoing challenges and systemic barriers.

Opportunities of the Social Contracting Model in the HIV Sector

1. Reducing Dependence on International Aid

Social contracting enables Vietnam to reduce its reliance on major international donors such as PEPFAR and the Global Fund. As international funding trends downward, transitioning to a social contracting approach allows mobilization of domestic resources—including state budgets and local civil society organizations—fostering a more self-sufficient and sustainable HIV response.

2. Enhancing Community Engagement

A core feature of the social contracting model is the active involvement of communities, particularly community-based organizations (CBOs) and social enterprises. Their participation improves the accessibility and effectiveness of HIV services, while also reducing stigma and discrimination. This is especially vital for high-risk groups such as men who have sex with men (MSM) and transgender individuals, who often face significant barriers to care.

3. Building a Sustainable HIV Care System

Social contracting provides a foundation for a more sustainable HIV service delivery system that can adapt independently of shifting donor priorities. Moving away from international aid toward domestic resource mobilization helps not only maintain existing services but also expand and diversify offerings to better meet the evolving needs of key populations.

Challenges and Barriers in Implementing Social Contracting in Vietnam

1. Limited Financial Capacity

Despite its potential to mobilize domestic resources, financial constraints remain a significant barrier. Vietnam’s current public health budget is insufficient to fully cover comprehensive HIV services for high-risk populations. As international support diminishes, financial pressure on both government agencies and civil society groups increases, making service continuity more difficult.

2. Lack of Comprehensive Legal and Policy Frameworks

One of the major obstacles in rolling out social contracting is the absence of a cohesive legal and policy infrastructure. Although pilot projects have been implemented in several provinces, the lack of clear regulations regarding roles, responsibilities, and entitlements among stakeholders hinders systematic evaluation and limits the model’s scalability nationwide.

3. Weak Monitoring and Evaluation Systems

Effective monitoring and evaluation (M&E) are essential for the success of any contracting mechanism. However, Vietnam currently lacks strong tools and frameworks to assess the performance and impact of HIV services delivered through social contracting. This gap compromises quality control and could lead to inefficient use of resources.

4. Scalability and Sustainability Concerns

Maintaining and scaling up the social contracting model remains a significant challenge. While early-stage pilots show promise, nationwide implementation requires coordinated efforts among government bodies, civil society, and social enterprises. Limited financial and human resources present further hurdles to broader rollout.

5. Limited Capacity Among Community-Based Organizations and Social Enterprises

Although community-based organizations and social enterprises play a critical role in the social contracting model, their effective participation is still limited. Many CBOs lack the capacity to manage and deliver large-scale services, while social enterprises often struggle with financial sustainability and operational challenges.

Conclusion

The social contracting model in HIV service delivery represents a strategic opportunity for Vietnam to reduce dependency on foreign aid and promote community engagement in healthcare provision. Nevertheless, for the model to truly thrive and expand, it is essential to address key barriers related to funding, legal frameworks, and M&E systems.

With strong government support and active involvement from civil society, social contracting can become a sustainable solution that enables Vietnam to achieve its national target of ending the HIV/AIDS epidemic by 2030. Legal reform, system strengthening, and empowering community organizations will be critical to ensuring the model’s long-term success and scalability.