Social Contracting Guidelines for HIV Services in Vietnam

Despite efforts from government, civil society, and the donor community, much work remains to be done to meet the Joint United Nations Programme on HIV/AIDS' (UNAIDS') 90-90-90 targets by 2020 and to end AIDS by 2030. As of mid-2019, 211,996 people were living with HIV in Vietnam, with 199,544 of them having AIDS. The number of new HIV cases has gradually decreased from 11,680 in 2014 to 10,453 in 2018, and the percentage of HIV-positive patients being treated at public health clinics has reached 64.2%. The Vietnam Administration for HIV/AIDS Prevention and Control (VAAC) has identified several priority interventions for the national HIV/AIDS control program's focus between 2015 and 2020. These include expanded community-based HIV testing, HIV self-testing, contact tracing, and index testing, as well as HIV-positive case identification and linkage to care and treatment. The VAAC has also emphasized the importance of improving HIV-positive case finding and initiation of antiretroviral treatment to achieve epidemic control. Community-based HIV services in Vietnam, largely implemented by members of key and priority populations, have played a key role in the national AIDS prevention and control program's success. These grassroots efforts have mobilized, cared for, and supported a vast number of people who inject drugs, people living with HIV, sex workers, men who have sex with men, and sex partners of high-risk people who the public system is often unable to reach. Despite the active involvement of civil society organizations (CSOs) in Vietnam's HIV response, the role of CSOs remains unclear in legislative and program documents, and the linkage between the state and CSOs is still limited. Vietnam's major challenges in the coming years include its ability to effectively, quickly, and sustainably increase coverage of quality health services for key and priority populations in the context of rapidly decreasing donor funding and limited domestic investment in HIV programming. The Vietnamese government has recognized the importance of social contracting as a mechanism to mobilize CSOs to sustain provision of HIV, health, and other social services with public funds. Social contracting has been successfully used in other countries, such as India, Malaysia, Thailand, and China, which share similarities with Vietnam's social, political, and HIV epidemic context. The government has also emphasized the need to improve the national administrative and health systems as well as the competence and sustainability of community-based service delivery to ensure a smooth transition from donor dependence to domestic funding. The Health Policy Plus (HP+) project, funded by the U.S. Agency for International Development (USAID), has been supporting the development of social contracting guidelines for HIV services in Vietnam. The guidelines aim to provide a framework for the government to engage with CSOs in the delivery of HIV services, including community-based HIV testing, HIV self-testing, contact tracing, and index testing, as well as HIV-positive case identification and linkage to care and treatment. The guidelines outline the purpose and scope of social contracting, the role of CSOs in HIV programs, and the government policies and regulations guiding social contracting. The document also provides information on the budgeting process for social contracting, the procedures for selecting CSOs for social contracts, and the internal procedures for budget estimation of social contracts. The guidelines aim to provide a clear and comprehensive framework for the government to engage with CSOs in the delivery of HIV services and to ensure the sustainability of community-based service delivery.