Ensuring health service continuity through the “Four-on-the-Spot” framework in Viet Nam

Viet Nam’s Ministry of Health has institutionalised the “Four-on-the-Spot” principle - local command, local forces, local resources, and local logistics - into the health sector’s disaster preparedness and response system. Formalised through national disaster management laws and ministerial guidelines, the approach ensures that provinces and districts integrate health service continuity into local disaster and adaptation plans. Measures include pre-positioning of medicines, medical supplies, and emergency transport, as well as community-based training for health workers in epidemic control and first aid. Provincial health departments in Binh Dinh, An Giang, and Thua Thien Hue have developed localised contingency plans addressing specific climate-related vulnerabilities. 

The success of this intervention stems from the strong legal and policy framework provided by the 2013 Law on Natural Disaster Prevention and Control. Decentralisation of planning responsibilities ensures that provincial health departments adapt national guidelines to local contexts. Regular drills, stockpiling mechanisms, and integration into existing health services reduce delays in response and minimise service disruption. Support from international partners such as WHO, GIZ, and the World Bank has further enhanced capacity-building through training, community-based disaster risk management programmes, and technical support for health system resilience.