After the ravages of war and adoption of the Doi Moi economic reforms in 1986, Viet Nam entered a period of sustained growth. However, the reforms contributed to government disinvestment in a health care system rated among the lowest performing globally in a 2000 World Health Organization report. In particular, ethnic minorities, impoverished people, and others living in rural areas lacked access to quality care.

When Charles F. "Chuck" Feeney, founder of The Atlantic Philanthropies, visited Hue Central Hospital in 1998, he saw an overcrowded, underfunded facility serving a region of 20 million people. Atlantic went on to make multiple investments at this site, relying on the construction expertise of East Meets West Foundation (EMWF). This included funding a Cardiovascular Center, which introduced a center of excellence model that several of the hospital's advanced care specialties would later adopt. Atlantic support attracted new investment by government and other funders to grow the hospital campus and its capabilities, helping Hue Central become one of the top three hospitals and medical training centers in Viet Nam.1 After Atlantic's investments in hospitals at Hue, and later Da Nang, it was clear that these facilities would become even more crowded -- the number of patients grew dramatically as the quality of care improved.

Atlantic saw that the poor state of health care in Viet Nam resulted from too little emphasis on primary care. Atlantic's strategy evolved to consider the system as a continuum of care -- spanning local prevention and treatment centers to specialized central hospitals. By 2003, Atlantic had opened an office in Ha Noi and hired Vietnamese program executives who began to forge a relationship with members of the provincial and national government. A shared vision emerged among government officials, care providers, and foundation staff, setting the stage for Atlantic to pilot models that could systematize delivery of health care and prevention services in the nation's 11,000 commune health centers (CHCs). Working closely with the Provincial Health Service, local governments, and residents, Atlantic expanded from pilot sites to ultimately build or renovate 940 CHCs across eight underserved provinces to demonstrate models for the rest of the country.

New facilities at the Hue Central Hospital as well as the redesigned and rebuilt local health centers helped elevate the standards of care in Viet Nam. These projects resulted from Atlantic's decision to invest in Viet Nam's health care system as a way to improve lives on a large scale and advance health equity for vulnerable populations. Viet Nam's big, multi-tiered health care system requires greater resources to realize full improvement, and today funders from Australia, Japan, and the United States are making investments to strengthen the system. The national government's resources and ability to support the transformed system have also increased.

This report focuses on capital projects in two tiers of the system -- a central hospital (tertiary care) and pilot commune health centers (primary care). These projects were instrumental in Atlantic's comprehensive strategy, representing $21.8 million of the $269 million it invested in the national continuum of care over 15 years. Case study research was conducted by MASS Design Group in August 2015. Funded by The Atlantic Philanthropies, this study illustrates how capital projects supported by public-philanthropic partnerships can initiate large-scale interventions that can dramatically improve public health care systems and services.