{
  "Rearrangement of Health Sector Units": "## Rearrangement of Health Sector Units\n\n### Reorganization of Provincial-Level Health Authorities and Public Service Units\n\nThe implementation of the 2-level local government model in Vietnam has necessitated a significant rearrangement and reorganization of health sector units across all administrative levels. At the provincial level, the primary directive involves the establishment of new Provincial Departments of Health (Sở Y tế) in provinces and centrally-run cities that undergo administrative boundary adjustments, mergers, or consolidations. These new Sở Y tế are formed by merging the existing Provincial Departments of Health from the pre-rearrangement provinces or cities. The newly established Sở Y tế will function as specialized agencies under the Provincial People's Committee (Ủy ban nhân dân cấp tỉnh) or Centrally-run City People's Committee (Ủy ban nhân dân thành phố trực thuộc Trung ương) after the rearrangement ([Source 1](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)).\n\nThe functions, duties, and powers of these reorganized Sở Y tế are to be carried out in accordance with the regulations outlined in Circular 37/2021/TT-BYT dated December 31, 2021, issued by the Ministry of Health, which provides guidance on the functions, duties, and powers of Provincial Departments of Health. Additionally, a new Circular 20/2025/TT-BYT, issued by the Ministry of Health on June 23, 2025, further guides the functions, duties, and powers of specialized health agencies under the Provincial People's Committees and commune-level People's Committees ([Source 3](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)). Based on these guidelines, the Director of the Provincial Department of Health is responsible for developing a proposal for the organizational structure (including departments and sub-departments) of the Sở Y tế, which is then submitted to the Provincial People's Committee for approval. This structure must align with local management requirements for health-related fields and adhere to the criteria stipulated in Decree 45/2025/NĐ-CP of the Government, which regulates the organization of specialized agencies under provincial and district-level People's Committees ([Source 6](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)).\n\nA critical aspect of this rearrangement involves the public service units directly under the Provincial Department of Health. Directors of the reorganized Sở Y tế are tasked with reviewing and evaluating the functions, duties, powers, and operational effectiveness of existing public service units (such as specialized hospitals, medical examination centers, forensic centers, social protection facilities, and district-level medical centers) prior to rearrangement. Following this assessment, they advise the Provincial People's Committee on decisions to maintain, dissolve, or reorganize these units (through mergers, divisions, separations, or adjustments to names and functions) ([Source 6](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). The guiding principle is to merge or dissolve public service units that are operating inefficiently, no longer have relevant functions, or have overlapping responsibilities with other units ([Source 7](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). For provinces and cities not undergoing mergers or rearrangements, existing provincial-level health facilities are generally maintained. However, district-level medical centers (Trung tâm Y tế cấp huyện, quận, thị xã) are to be reorganized into regional medical centers (Trung tâm Y tế khu vực), which will operate as public service units directly under the Provincial Department of Health ([Source 7](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). This aims to consolidate service delivery across broader areas.\n\n### Dissolution of District-Level Health Divisions and Shifting Responsibilities\n\nA significant change in the health sector's administrative structure under the 2-level local government model is the dissolution of Phòng Y tế (District Health Divisions) at the district, urban district, and town levels. According to the Ministry of Health's guidance, these divisions will cease operations. Their state management functions, which previously involved advising on health matters, are being transferred to the Phòng Văn hóa - Xã hội (Culture and Society Division) and the Trung tâm hành chính công (Public Administration Service Center) at the commune (cấp cơ sở) level after the rearrangement ([Source 8](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). This move reflects the broader objective of streamlining the administrative apparatus by eliminating the district-level government as an operational tier, thereby shifting direct governance responsibilities to the provincial and commune levels.\n\nThe transfer of these functions means that the commune-level People's Committees (Ủy ban nhân dân cấp cơ sở) will assume greater direct responsibility for state management in health-related fields within their jurisdiction. This decentralization aims to bring administrative services closer to the populace, enabling more direct and timely responses to local health needs. However, it also presents challenges in terms of capacity building and resource allocation at the commune level, as these entities must now absorb and effectively manage responsibilities previously handled by a dedicated district-level health division. The success of this transition hinges on clear guidance, adequate training, and sufficient resources for the commune-level authorities to fulfill their expanded roles in health governance.\n\n### Restructuring and Management of Commune Health StationsUnder the new 2-level local government model, commune health stations (Trạm Y tế xã, phường, đặc khu) are undergoing significant restructuring, primarily concerning their management. These grassroots health facilities are being transferred to the direct management of the commune-level People's Committees of the newly rearranged administrative units ([Source 4](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)). This change is intended to ensure that healthcare services remain accessible and responsive to the local population, maintaining continuity of care at the community level.\n\nHowever, the transition has faced practical difficulties, particularly due to the initial absence of a comprehensive guiding circular detailing the functions, duties, powers, and organizational structure of these commune health stations under the new 2-level model. As of early September 2025, this lack of specific guidance has complicated the advisory role for the new commune-level People's Committees in the health sector ([Source 3](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)). In response, the Ministry of Health has been actively drafting and subsequently issued Circular 20/2025/TT-BYT on June 23, 2025, to provide this essential guidance. This circular outlines the functions, duties, and powers of specialized health agencies belonging to both provincial-level and commune-level People's Committees ([Source 3](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)).\n\nThe objective behind transferring commune health stations to commune-level management is to safeguard the provision of healthcare services directly at the grassroots level and ensure sufficient facilities for the local population ([Source 4](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)). This approach emphasizes local accountability and direct oversight, aiming to enhance the responsiveness and effectiveness of primary healthcare. However, successful implementation relies heavily on the clarity of the new legal framework and the capacity of commune-level authorities to manage these essential health facilities effectively.\n\n### Human Resources and Operational Continuity in the Health Sector\n\nEnsuring the uninterrupted operation and effective service delivery of the health system, particularly at the grassroots level, is a critical concern during the transition to the 2-level local government model. To address potential disruptions, the Ministry of Health, through a dispatch signed by Minister Đào Hồng Lan on August 29, 2025 (Document No. 5851/BYT-TCCB), has directed provincial/city Departments of Health to develop plans for the rotation, transfer, and deployment of personnel. This includes mobilizing staff from the Provincial Department of Health, hospitals, and medical centers directly under the Provincial Department of Health, as well as other relevant units of the Provincial/City People's Committee, to the commune level ([Source 9](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)).\n\nSpecifically, these plans mandate the deployment of at least one medical professional to the Phòng Văn hóa xã hội (Culture and Society Division) and at least one doctor to each commune health station. This strategic allocation of human resources aims to guarantee that the grassroots health system remains functional and capable of providing a full range of specialized and technical services, thereby meeting the demands of the new 2-level local government organizational model ([Source 9](https://baochinhphu.vn/bo-y-te-dang-du-thao-huong-dan-co-cau-to-chuc-cua-tram-y-te-xa-102250903155300267.htm)). The emphasis on deploying doctors to commune health stations directly addresses concerns about maintaining the quality and scope of medical care at the most fundamental level of the healthcare system.\n\nThis human resource strategy is part of a broader effort to manage the workforce impact of the administrative rearrangement. The overall initiative involves a comprehensive review and adjustment of staffing norms and professional standards across various sectors, including health. The goal is to ensure that the new administrative structure is adequately staffed with competent personnel, preventing any gaps in service delivery as the new model becomes fully operational. The government's commitment to this \"administrative revolution\" acknowledges the significant workload and potential challenges, emphasizing a pragmatic approach of \"doing, learning, and adjusting\" to ensure effectiveness and suitability to local realities ([Source 14](https://baochinhphu.vn/chinh-quyen-dia-phuong-2-cap-se-van-hanh-tu-1-7-2025-ca-he-thong-chinh-tri-buoc-vao-cuoc-nuoc-rut-lich-su-102250611122819752.htm)).\n\n### Policy Framework and Implementation Challenges for the Health Sector\n\nThe rearrangement of health sector units is an integral part of the broader national initiative to establish a 2-level local government model, driven by a robust policy framework. Key directives include Conclusion No. 137-KL/TW dated March 28, 2025, from the Politburo and the Secretariat, concerning the project for rearranging administrative units at all levels and building the 2-level local government model ([Source 2](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). This is further supported by Decision No. 571/QĐ-TTg dated March 2, 2025, by the Prime Minister, establishing a Steering Committee for implementing the rearrangement ([Source 2](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)), and Resolution 74/NQ-CP dated April 7, 2025, from the Government, which promulgates the plan for administrative unit rearrangement and the 2-level local government model ([Source 1](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm), [Source 2](https://xaydungchinhsach.chinhphu.vn/huong-dan-sap-xep-co-so-y-te-cac-cap-thuc-hien-mo-hinh-to-chuc-chinh-quyen-dia-phuong-2-cap-119250416085846019.htm)). These documents collectively form the legal and political foundation for the comprehensive restructuring impacting the health sector.\n\nThe transition to the 2-level model, which became operational on July 1, 2025, for new administrative units ([Source 13](https://baochinhphu.vn/chinh-quyen-dia-phuong-2-cap-se-van-hanh-tu-1-7-2025-ca-he-thong-chinh-tri-buoc-vao-cuoc-nuoc-rut-lich-su-102250611122819752.htm), [Source 17](https://baochinhphu.vn/hoan-thien-mo-hinh-chinh-quyen-dia-phuong-2-cap-bao-dam-van-hanh-hieu-qua-ngay-trong-2025-102250811153627551.htm)), represents a \"major administrative revolution\" ([Source 14](https://baochinhphu.vn/chinh-quyen-dia-phuong-2-cap-se-van-hanh-tu-1-7-2025-ca-he-thong-chinh-tri-buoc-vao-cuoc-nuoc-rut-lich-su-102250611122819752.htm)). This involves not only the rearrangement of provincial and commune-level units but also the cessation of district-level operations and the reorganization of local government into two tiers. Such a large-scale transformation inevitably leads to challenges and complexities. The government acknowledges that issues are unavoidable and emphasizes a flexible approach of \"doing, learning, and adjusting\" to ensure effectiveness and suitability to practical realities ([Source 14](https://baochinhphu.vn/chinh-quyen-dia-phuong-2-cap-se-van-hanh-tu-1-7-2025-ca-he-thong-chinh-tri-buoc-vao-cuoc-nuoc-rut-lich-su-102250611122819752.htm)).\n\nA significant challenge lies in the need for comprehensive legal frameworks, decentralization guidelines, and appropriate financial mechanisms to support the new model. Ministries and agencies are tasked with urgently reviewing, developing, and perfecting legal provisions on decentralization, clearly defining duties and powers between provincial and commune-level governments in each sector, including health ([Source 16](https://isos.gov.vn/nghien-cuu-trao-doi/sap-xep-don-vi-hanh-chinh-va-to-chuc-chinh-quyen-dia-phuong-2-cap-o-viet-nam-buoc-di-dot-pha-trong-cach-mang-tinh-gon-to-chuc-bo-may-nha-nuoc-43760.html)). The Prime Minister has directed ministries and agencies to focus on guiding administrative procedures, budget management, organizational structure, and human resource management for provincial and commune levels by August 2025, ensuring alignment with the authority of each level ([Source 15](https"
}