Local implementation of the climate-resilient and environmentally sustainable health care facilities (CRESHCF) Framework in Viet Nam
Categories: Country experience, Western Pacific, Climate Resilient Health Systems, Low Carbon Sustainable Health Systems
Country: Viet Nam
Local counterparts and WHO staff visiting the new water treatment plant Cu Lao Minh Area General Hospital. The upgraded saltwater filtration system supported by WHO has been capable of running 12 hours a day and purifying 1000 litres per hour – enough for the hospital’s needs. Credit: WHO Viet Nam Context
Viet Nam is one of the most disaster-prone countries in the world. With a coastline stretching 3440 km, combined with a diverse and complex topography, Viet Nam suffers from many different types of natural hazards. These are both hydrometeorological (e.g., typhoon, floods, heavy rainfalls, saltwater intrusion and droughts) and geophysical (e.g., landslides). It is estimated that approximately 70% of the population living in coastal areas and low-lying deltas in Viet Nam are exposed to the risk of flooding.
Climate change effects health in many ways, including the safety and security of health care infrastructure.
Almost half of health care facilities in Viet Nam do not have a reliable supply of clean water. Many lack secure and clean energy sources and safe waste management- all of which are essential for safe health care. A reliable source of safe water is essential for effective infection prevention and control (IPC) in health care facilities to prevent avoidable infections, including those caused by antimicrobial resistant (AMR) pathogens. Patients, health-care workers, and the community are at risk.
Storms, floods, drought and salt-water intrusion - worsened by climate change – are increasing the risks.
Health care facilities are particularly vulnerable to climate change, as they often lack stable infrastructure, adequate sanitation, and reliable supplies of water and energy. Disasters can disrupt health care – as seen with Typhoon Yagi, which damaged more than 800 health care facilities in September 2024.
Globally, the health sector contributes nearly 5% of total greenhouse gas emissions – through energy consumption, health care supply chains, and poor management of health care waste, which can also pollute the environment.
Implementation process
Since 2021, the World Health Organization (WHO) has been working with the Ministry of Health’s Viet Nam Administration Disease Prevention (VADP), formerly the Health Environment Management Agency (VIHEMA) to pilot tailored solutions to adapt to and mitigate climate risks at hospitals in Lao Cai, Nghe An and Vinh Long (formerly Ben Tre) Provinces – selected based on their high vulnerability to climate change.
The four components of the pilot model are: water, sanitation and hygiene (WASH), and health care waste management; capacity building and awareness raising; energy efficiency and green energy; and improved infrastructure, technology and products.
Solutions were adapted to specific conditions in the three health care facilities. For example:
- In a Mekong Delta hospital in Vinh Long Province, at risk from droughts, floods and saltwater intrusion, WHO supported the installation of a brackish water desalination system to improve the quality and quantity of water available to the hospital, which serves 500,000 people. Solar energy panels and more efficient energy use have enabled the hospital to save 20% of its energy costs, which are now being reinvested to fund quality improvements.
- In central Viet Nam, Yen Thanh Hospital in Nghe An Province faced unreliable water supply. Water is being cut off twice a year during harvest season due to competing agricultural demands and technical issues like low pressure and distance from the water supply network. With WHO support, local actors and authorities built a dedicated waterline for the hospital. Now, it has a reliable system supplying 200 cubic meters of water per day, meeting patient care and operational needs.
- A hospital in the mountainous Lao Cai, Bac Ha Province, suffered from unreliable sources of gravity-fed water when underground water is unavailable, even when drilling deep down to 200 meters. WHO supported the installation of a rainwater-for-drinking (RFD) system, including components for catchment, storage and treatment.
- All three hospitals have improved handwashing and hygiene facilities, including new separate toilets for women and men, accessible to patients, staff, and visitors. One hospital replaced its incinerator with a microwave-based system for the treatment of infectious medical waste and trained staff to ensure sustainable operation of the new system.
The aim of the pilot was to support the government in developing and rolling out national guidelines, enabling other health care facilities to benefit equally. This helps strengthen climate resilience across the health system and enables facilities to serve their communities more safely and sustainably.
Credit: WHO Viet Nam
Lessons learned
The pilot models constitute proofs-of-concepts and help build commitment among decision-makers and facility leadership to strengthen climate resilience and environmental sustainability. Among the results reported by the hospitals are:
- Decreased hospital-acquired infections: “The upgrades on the water supply had lowered the rate of infections for babies and adults, and the cleaner facilities had drawn more patients, who in the past might have travelled to higher-level hospitals”.
- Reliable safe water supply, even during drought or flood seasons: Staff, patients and visitors no longer have to buy and bring bottled drinking water to the hospitals
- Financial savings from the energy reduction achieved can be reinvested to improve quality of care
- A measured reduction in toxic gases and greenhouse gas emissions has been achieved by replacing incinerators with a microwave system to treat infectious waste
- Improved patient and staff satisfaction
- Increased patient attendance: At Cu Lao Minh Hospital, outpatient visits rose from 1,000 to 1,500 patients per day. Safer and more reliable grassroots health care is now available within communities; reducing the need for people to take time off work and pay for travel to health care facilities that are further away.
Challenges
- Clear need for increased support from donors, development partners, and the private sector. Funding mobilization is critical to advancing climate resilience in healthcare facilities and ensuring long-term sustainability.
- High upfront investments required to improve energy efficiency and to replace outdated incineration systems with cleaner, safer waste treatment technologies. These investments are essential to reduce emissions and improve environmental health, but they require significant financial commitments
- Raising awareness among healthcare facility staff about the benefits and positive impacts of the framework on daily operations and patient health outcomes remains essential.
Success factors
Success factors included:
- Solutions were tailored to the needs of each health care facility
- Trusting relationships with hospital leadership and partners such as the local government, provincial Departments of Health and provincial Centres for Disease Control
- Support and leadership from the Ministry of Health and local counterparts
A WHO-supported project is delivering safer water, which is crucial for protecting babies from infection.
Credit: WHO Viet Nam
Recommendations
After piloting the CRESHCF framework in three sites, the WHO Viet Nam Country Office is now working closely with national counterparts to develop national guidelines that will help accelerate the broader implementation of the framework across the country.
When selecting the healthcare facilities for these pilots, the decision was made to include sites from Viet Nam’s three main regions, each with distinct geographic and climatic conditions. Testing the framework across this diverse scope allowed us to identify and address many of the key climate risks faced by healthcare facilities nationwide.
The local piloting has also been a milestone in engaging our national counterparts. Tailoring the framework to Viet Nam’s context, identifying specific local needs and financial gaps as well as the possibility of private sector engagement, have directly contributed to the progress we are making now toward scaling up implementation.
A key element for successful implementation was the engagement and ownership demonstrated by hospital staff. For future efforts, it will be crucial to identify “local champions” who recognize the benefits the framework brings to daily operations and the quality of patient care.
Key resources
Additional information: