Lower-Carbon Clinical Care in Viet Nam: Reducing Avoidable Emissions Without Compromising Patient Safety

Lower-Carbon Clinical Care in Viet Nam: Reducing Avoidable Emissions Without Compromising Patient Safety

IMPLEMENTATION INSIGHTS · HEALTHCARE SUSTAINABILITY & ESG

Last reviewed: October 27, 2026

A hospital may invest in energy-efficient equipment, improve waste segregation, and reduce unnecessary packaging while paying relatively little attention to the environmental impact of the clinical care it delivers.

Yet decisions made during patient care can also influence greenhouse gas emissions.

An anesthesiologist's choice of anesthetic technique may affect emissions associated with volatile anesthetic agents. A clinician selecting an inhaler for someone with asthma or chronic obstructive pulmonary disease may be choosing between devices with different environmental footprints. The products used during a procedure and the way a care pathway is organized can also influence the resources consumed throughout treatment.

These are clinical decisions first. Their primary purpose is to provide safe, effective, and appropriate care, and environmental considerations should not undermine that responsibility.

This creates an important challenge for healthcare organizations seeking to reduce emissions. A product with a smaller carbon footprint may have different clinical characteristics. An alternative treatment technique may require equipment or specialist expertise that is not available in every facility. A change intended to reduce resource consumption may also have unintended consequences if it affects treatment effectiveness, patient access, or safety.

For Viet Nam, lower-carbon clinical care should therefore be approached through evidence-based practice, clinical governance, and healthcare quality improvement rather than environmental targets alone.

The objective is not to reduce the care patients need. It is to identify opportunities to avoid unnecessary emissions while maintaining, and where possible improving, clinical quality and patient safety.

This requires collaboration among clinicians, pharmacists, quality and patient safety professionals, environmental specialists, and healthcare leaders.

The central question is how healthcare organizations can make clinically appropriate changes that deliver credible environmental benefits without introducing additional risks or disadvantages for patients.

Why Clinical Care Matters for Healthcare Decarbonization

Healthcare organizations contribute to greenhouse gas emissions through many activities, including electricity consumption, transportation, purchased products, pharmaceutical manufacturing, medical equipment, and waste treatment.

Some emissions are closely associated with the delivery of clinical care itself.

Volatile anesthetic agents and nitrous oxide can contribute directly to greenhouse gas emissions when released into the atmosphere. Many conventional pressurized metered-dose inhalers contain propellants with high global warming potential. Clinical products and procedures also have environmental impacts associated with manufacturing, sterilization, transportation, use, and disposal.

These sources differ in how emissions arise and how they might be reduced.

The World Health Organization's Operational Framework for Building Climate Resilient and Low Carbon Health Systems, published in November 2023, recognizes the importance of strengthening healthcare resilience while reducing the environmental impact of health systems.

In December 2025, WHO published Measuring Greenhouse Gas Emissions in Health Systems, providing guidance on consistent emissions measurement, identifying priorities, and supporting accountability.

These resources establish a useful foundation, but healthcare decarbonization should not be understood solely as an exercise in calculating emissions.

Within clinical care, environmental improvement needs to be considered alongside treatment effectiveness, professional standards, patient preferences, available alternatives, and access to appropriate services.

A measure that reduces emissions from one activity may increase resource consumption elsewhere. A product that performs favorably in a carbon footprint comparison may have different implications when its clinical use, supporting equipment, and wider care pathway are considered.

Lower-carbon clinical care therefore requires more than environmental information. It needs clinical judgment, credible evidence, appropriate implementation, and evaluation of the outcomes that matter to patients.

What International Guidance Tells Us About Clinical Decarbonization

The Institute for Healthcare Improvement (IHI) has developed practical resources addressing emissions associated with clinical activities.

Its 2024 guide, Accelerating Decarbonization in Clinical Care, examines opportunities involving anesthetic gases, inhalers, and medical products. It also provides examples of improvement activities and approaches to measuring their environmental effects.

In 2025, IHI published Getting Started with Clinical Decarbonization, drawing on experiences from healthcare improvement initiatives conducted between 2022 and 2025.

The publication emphasizes organizational support, clearly defined improvement objectives, and small-scale testing before changes are introduced more widely.

This approach is particularly relevant to clinical practice because an environmental intervention needs to be clinically suitable, operationally feasible, acceptable to those delivering and receiving care, and supported by appropriate evidence.

Implementation may depend on clinical protocols, pharmacy arrangements, equipment availability, professional training, and the organization's ability to monitor outcomes.

WHO's Indicators of Climate Resilience and GHG Emissions in Health Systems, published in March 2026, provides additional guidance on monitoring progress across the components of its operational framework.

However, these international resources have different purposes. WHO's health-system indicators, IHI's quality improvement guidance, and clinical recommendations issued by professional organizations should not be treated as interchangeable.

Nor do they automatically establish mandatory clinical decarbonization requirements for healthcare facilities in Viet Nam.

Their value lies in helping healthcare professionals identify potential opportunities, understand the evidence supporting them, and consider the conditions necessary for responsible implementation.

Anesthetic Gases: Where Clinical Practice and Environmental Impact Intersect

Anesthetic gases have received considerable international attention because some commonly used agents are potent greenhouse gases.

Desflurane, sevoflurane, isoflurane, and nitrous oxide differ in their pharmacological characteristics and environmental effects.

Desflurane has a substantially higher 100-year global warming potential than several other commonly used volatile anesthetic agents. Nitrous oxide is also an important greenhouse gas, with emissions potentially arising from clinical administration and losses within supply and distribution systems.

These characteristics create opportunities to examine whether avoidable emissions can be reduced.

However, anesthetic selection must remain based on the patient's condition, the procedure, the clinical setting, available equipment, and the judgment of qualified anesthesia professionals.

Different agents and techniques may have different implications for induction, maintenance of anesthesia, emergence, postoperative recovery, and other aspects of care.

Environmental performance is therefore one consideration among several, not a substitute for clinical assessment.

International experience suggests that healthcare organizations may have opportunities to review the use of high-emission agents, reduce avoidable anesthetic gas consumption, identify losses from supply systems, and consider alternative techniques where clinically appropriate.

Such changes require specialist oversight.

For example, lower fresh gas flow techniques may reduce volatile anesthetic consumption under suitable conditions. However, appropriate flow settings and monitoring arrangements depend on anesthesia equipment, patient characteristics, clinical technique, and applicable professional requirements.

Similarly, total intravenous anesthesia or regional anesthesia may offer environmental advantages in selected circumstances. Neither should automatically be assumed preferable for every patient or procedure.

Different techniques involve different medicines, equipment, consumables, professional skills, and clinical considerations.

The objective is not to eliminate an anesthetic agent or technique without understanding its clinical role. It is to identify where appropriate alternatives or improvements in practice can reduce emissions while maintaining safe anesthesia care.

What Recent Research Reveals About Anesthesia Emissions

Two studies published in September and October 2026 provide useful evidence about the opportunities and limitations of anesthetic decarbonization.

On September 28, 2026, Sutin and colleagues published a multicenter study in Anesthesia & Analgesia examining system-level interventions intended to reduce greenhouse gas emissions associated with anesthetic gases.

The researchers analyzed 148,762 general anesthesia cases from 11 facilities within the New York City Health + Hospitals system between April 2022 and December 2025.

The study evaluated clinical decision support intended to reduce fresh gas flow and the deactivation of central nitrous oxide distribution systems at three hospitals.

An important finding concerned losses from centrally supplied nitrous oxide.

At Bellevue Hospital, the researchers estimated that approximately 94.6% of nitrous oxide supplied through the central system was lost before reaching patients.

This finding illustrates how emissions may arise from supporting infrastructure rather than clinical administration alone. However, the estimate relates to that hospital's particular supply arrangements and should not be generalized to all healthcare facilities.

The researchers found that deactivation of central nitrous oxide systems was associated with a statistically significant reduction in nitrous oxide-attributable emissions. The association with total anesthetic emissions in the primary model, however, did not reach conventional statistical significance.

The clinical decision support intervention was associated with smaller but statistically significant reductions in fresh gas flow and the estimated overall hourly emissions rate.

These distinctions matter because the results should not be summarized as though every intervention produced the same effect on every emissions measure.

The study demonstrates the potential value of examining clinical practice and supporting infrastructure together, but it remains an observational investigation conducted within a particular healthcare system.

Its findings do not establish that identical interventions would achieve the same outcomes in Viet Nam. Any change to medical gas infrastructure would also require appropriate assessment of clinical needs, alternative supply arrangements, technical safety, and applicable professional requirements.

A second study, published online in Anaesthesia and Intensive Care on October 9, 2026, examined hospital-based interventions intended to reduce desflurane use.

Verlis and colleagues conducted a systematic review of 23 studies, including three randomized controlled trials, seven interrupted time-series studies, and 13 uncontrolled before-and-after studies.

All studies reporting evaluable changes in desflurane consumption, greenhouse gas emissions, or costs found reductions favoring the interventions examined. Specifically, 17 studies reported reductions in desflurane consumption, 16 reported reductions in greenhouse gas emissions, and 14 reported cost reductions.

However, the authors assessed the certainty of the evidence as very low because of methodological limitations, risk of bias, differences in outcome measures, and other concerns.

The studies were conducted in high-income countries, further limiting how confidently their findings can be generalized to healthcare systems with different resources and clinical arrangements.

Together, these publications suggest that opportunities exist to reduce avoidable anesthetic emissions, but they also demonstrate the need for careful evaluation.

A reduction in anesthetic gas consumption is not evidence, by itself, of improved patient safety. Clinical and environmental outcomes should be assessed separately, even when both are relevant to the same improvement initiative.

Why Vietnamese Clinical Evidence Also Matters

Clinical practice in Viet Nam may differ from the healthcare systems represented in international decarbonization studies.

Available medicines, anesthesia equipment, professional training, patient populations, clinical protocols, and financing arrangements can influence which approaches are practical and appropriate.

A study published in the Vietnam Medical Journal on October 6, 2026, provides an example of why clinical differences between anesthetic agents need to be considered.

Researchers at Tam Anh General Hospital in Ha Noi compared recovery characteristics following desflurane and sevoflurane anesthesia in 30 patients undergoing percutaneous nephrolithotomy.

The randomized study included 15 patients in each group and assessed outcomes such as emergence time, tracheal extubation time, and recovery milestones.

Patients receiving desflurane reached selected recovery milestones sooner than those receiving sevoflurane.

However, the study involved a small sample and one type of procedure. It was not designed to compare greenhouse gas emissions or establish the relative safety of the two agents across a broad range of clinical circumstances.

Its findings should therefore not be interpreted as demonstrating that desflurane is environmentally preferable or that the observed recovery differences apply to every surgical procedure.

The study is relevant to clinical decarbonization because it illustrates that anesthetic agents may differ in clinically important characteristics as well as environmental impacts.

Any proposal to change practice should consider these dimensions together.

There is also a broader evidence gap. Selected anesthesia studies in Viet Nam do not establish national consumption patterns, the total carbon footprint of anesthetic practice, or the readiness of Vietnamese healthcare facilities to implement particular decarbonization strategies.

Such conclusions require appropriate local data.

International research can inform professional discussion, but implementation decisions should reflect the clinical circumstances, available resources, and evidence relevant to the healthcare services involved.

Inhaler Choice: Environmental Benefits Must Follow Clinical Suitability

Inhalers provide another example of how clinical decisions can influence greenhouse gas emissions.

Medicines used to manage asthma and chronic obstructive pulmonary disease may be delivered through pressurized metered-dose inhalers, dry-powder inhalers, soft-mist inhalers, and other devices.

These technologies differ in how they deliver medication and in the techniques required for correct use.

Many conventional pressurized metered-dose inhalers use hydrofluorocarbon propellants with high global warming potential.

Dry-powder inhalers and certain other devices generally have lower propellant-related emissions, although their overall environmental footprints still depend on manufacturing, materials, distribution, use, and disposal.

These environmental differences can be meaningful, but inhalers are not clinically interchangeable simply because they are used to treat similar respiratory conditions.

A dry-powder inhaler requires the patient to generate appropriate inspiratory flow. A pressurized metered-dose inhaler requires suitable administration technique and may involve the use of a spacer in relevant circumstances.

Other devices have their own operating characteristics.

Patient age, inspiratory ability, dexterity, cognition, vision, preferences, medicine availability, and affordability can all influence whether a device is suitable.

These considerations are especially important for children, older people, and individuals who have difficulty using certain inhalers.

International clinical guidance increasingly recognizes environmental impact as one factor in inhaler selection.

The 2024 guideline on asthma developed by the British Thoracic Society, the National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network recommends considering the lowest environmental impact among inhaler devices that are suitable for the patient.

The guideline also emphasizes correct inhaler technique, patient preferences, and the presence of an integral dose counter.

The distinction between suitable devices and all available devices is essential.

Environmental considerations should inform choices among clinically appropriate options. They should not justify switching patients to devices they cannot use effectively.

Changing an inhaler may also involve changes to the medicine, dose, administration technique, or wider treatment plan.

A patient whose respiratory condition is well controlled should not have treatment changed solely to meet an environmental target without appropriate clinical assessment.

Poor disease control, incorrect inhaler technique, or reduced adherence may cause harm and increase the need for additional healthcare.

For these reasons, lower-carbon respiratory care should begin with accurate clinical assessment, effective treatment, suitable device selection, patient education, and ongoing review.

What Respiratory Guidance Means for Viet Nam

The Thoracic Society of Australia and New Zealand published a position statement in Respirology in 2025 examining the environmental effects of inhaled medicines and potential approaches to reducing their impact.

The authors emphasized accurate diagnosis, effective disease control, appropriate prescribing, correct device technique, and consideration of lower-carbon inhalers when clinically suitable.

They also highlighted that environmental considerations should complement established respiratory guidance rather than replace it.

Developments involving lower-global-warming-potential propellants may expand the range of inhaler options available in some markets.

However, international availability does not automatically mean that newer products have been authorized, marketed, or made affordable in Viet Nam.

Their clinical characteristics, regulatory status, supply reliability, and cost would need to be considered before they could become appropriate options for patients in a particular healthcare setting.

Vietnamese professional education also reinforces the importance of correct inhaler use.

On July 27, 2026, Gia Dinh People's Hospital published educational guidance on inhaled medicines for asthma and chronic obstructive pulmonary disease.

The guidance emphasized that effective treatment depends on selecting the correct medicine and device, using proper technique, and following the prescribed regimen.

Although the material did not evaluate greenhouse gas emissions, it illustrates an important clinical priority for sustainable respiratory care in Viet Nam.

Any initiative intended to reduce inhaler-related emissions must preserve effective treatment. Healthcare organizations should therefore avoid blanket substitution policies based solely on reported carbon footprints.

Where a clinically appropriate lower-carbon option exists, decisions should follow authorized prescribing, patient assessment, suitable communication, assessment of inhaler technique, and appropriate follow-up.

It is also important to recognize that NICE NG245 is an asthma guideline. Its recommendations should not automatically be extended to every patient with chronic obstructive pulmonary disease or another respiratory condition without reference to the appropriate disease-specific guidance.

Medical Products: Avoiding Unnecessary Use Without Compromising Care

Clinical care depends on a wide range of medical products and consumables.

Gloves, gowns, syringes, dressings, procedural packs, tubing, instruments, and other items have environmental impacts associated with their manufacture, transportation, use, and disposal.

Some products are essential for infection prevention and safe treatment. Others may be used in quantities or arrangements that deserve review.

A procedural pack, for example, may contain items that are routinely opened but not used. Additional products may sometimes be prepared because of established workflow arrangements rather than actual clinical requirements.

Reviewing such practices may help identify avoidable resource consumption without reducing necessary care.

However, the assessment must remain clinically grounded.

A product that appears unnecessary in one setting may be essential in another. Some disposable items are required because of infection prevention considerations, manufacturer instructions, or other safety requirements.

Similarly, replacing a single-use product with a reusable alternative is not automatically safer or environmentally preferable.

Reusable instruments and devices may require validated cleaning, disinfection, sterilization, inspection, maintenance, and traceability. These processes involve energy, water, chemicals, labor, and other resources.

Environmental comparisons should therefore consider the products involved, their lifecycles, and the conditions under which they are used.

Reuse or reprocessing must also comply with applicable Vietnamese requirements, product authorization, intended use, manufacturer instructions, and relevant professional guidance.

Healthcare organizations should not interpret sustainability objectives as permission to reuse medical devices that are not authorized or suitable for reuse.

The appropriate goal is to prevent avoidable consumption while preserving the products and procedures necessary for safe care. This is different from simply reducing purchasing volumes or the quantity of waste generated.

Lower-Carbon Care Should Not Mean Providing Less Care

One risk in clinical decarbonization is confusing reduced healthcare activity with improved environmental performance.

Fewer consultations, diagnostic tests, procedures, or treatment interventions may reduce certain resource demands. However, fewer services do not necessarily mean better care.

A clinically necessary test should not be withheld because of its estimated carbon footprint. A required procedure should not be delayed solely to meet an environmental target.

Reducing resource use is meaningful when the activity being avoided is genuinely unnecessary, inappropriate, duplicative, or otherwise not expected to provide clinical benefit according to appropriate evidence.

Even then, changes need to be assessed for unintended consequences.

A revised follow-up pathway, for example, should maintain suitable monitoring and timely access to care.

Remote consultations may reduce patient travel in some circumstances, but they are not appropriate for every clinical condition or patient. They also involve digital infrastructure, equipment, energy consumption, accessibility considerations, and potential risks associated with delayed physical assessment.

Their environmental benefits should therefore not be assumed solely because care is delivered remotely.

The same principle applies to other clinical improvements.

Preventing avoidable complications, improving medication safety, reducing inappropriate variation, and coordinating care more effectively may help avoid unnecessary resource use.

However, any environmental benefit should be evaluated rather than automatically inferred from the clinical improvement.

The objective is to deliver necessary care safely and effectively while avoiding environmental impacts that can reasonably be prevented.

Measuring Environmental Benefits Alongside Clinical Outcomes

Lower-carbon clinical care requires meaningful measurement, but environmental and clinical measures serve different purposes.

Greenhouse gas emissions are commonly expressed as carbon dioxide equivalent, or CO₂e, allowing different gases to be compared using appropriate conversion factors.

For an anesthetic gas initiative, environmental measures may include the quantities of selected agents used, relevant consumption patterns, and estimated emissions.

For an inhaler initiative, evaluation may consider the types and quantities of devices used and suitable estimates of their lifecycle emissions.

For medical products, assessment may examine product consumption, unnecessary opening of supplies, material use, and relevant lifecycle information.

The boundaries of each assessment need to be clear.

Emissions associated with product manufacturing are different from greenhouse gases released directly during clinical use. Similarly, an organization's greenhouse gas inventory is not interchangeable with a lifecycle assessment of an individual medicine, device, or clinical procedure.

The GHG Protocol distinguishes organizational emissions accounting from product lifecycle accounting.

WHO's December 2025 publication Measuring Greenhouse Gas Emissions in Health Systems emphasizes consistent methods, transparent boundaries, credible data, and appropriate interpretation.

For clinical improvement activities, measurement should reflect the intervention being evaluated and the environmental effects it is intended to change.

Published emission factors and lifecycle estimates may be useful, but they should not automatically be assumed to represent the exact products, energy sources, supply chains, or operating conditions of a healthcare facility in Viet Nam.

Comparisons should also account for clinical activity.

A reduction in total anesthetic gas consumption, for example, may reflect fewer procedures rather than an improvement in how anesthesia is delivered.

Where appropriate, environmental measures may need to be considered alongside procedure volumes, relevant case characteristics, or other indicators of clinical activity.

The same applies to inhaler-related emissions, which can be influenced by changes in patient numbers, treatment patterns, and medicine availability.

Most importantly, environmental outcomes should be evaluated alongside clinical quality and patient safety.

For anesthesia-related changes, qualified professionals may select relevant procedural, recovery, and safety outcomes.

For respiratory care, relevant measures may include disease control, exacerbations, inhaler technique, adherence, patient experience, and access to prescribed treatment.

Changes involving medical products may require consideration of infection prevention, product performance, and workflow reliability.

The purpose is not to combine emissions and patient safety into a single score. It is to determine whether an intervention produces a credible environmental benefit while maintaining appropriate clinical performance.

Moving From Evidence to Responsible Implementation

Healthcare organizations interested in clinical decarbonization do not necessarily need to begin with a large institution-wide program.

A more practical approach is to identify a focused opportunity supported by credible evidence and relevant to the services being delivered.

An anesthesia department may wish to better understand patterns of anesthetic gas use. A respiratory service may consider whether environmental information could appropriately inform existing inhaler education and prescribing review processes. Another department may review avoidable consumption of products routinely opened but not used.

The first task is to define what the organization is trying to improve.

Relevant professionals can then review the evidence, consider clinical implications, examine local feasibility, and determine whether a change is appropriate.

Clinical leadership is particularly important where proposals involve medicines, anesthetic techniques, medical devices, or established treatment pathways.

Pharmacists, biomedical engineering personnel, infection prevention teams, quality professionals, and other specialists may contribute according to the intervention.

Where a change is clinically appropriate and operationally feasible, a limited improvement activity may help the organization understand its actual effects before considering wider implementation.

Quality improvement methods can support this process by examining whether intended changes occur and whether unexpected problems emerge.

However, activities presented as routine improvement should not be used to bypass requirements applicable to clinical research, professional authorization, informed consent, or other regulated activities.

The distinction between quality improvement and research should be determined according to the nature and purpose of the work and applicable requirements.

Monitoring should consider both environmental and clinical outcomes, with attention to unintended effects.

If an intervention adversely affects treatment effectiveness, patient safety, or access, the organization should review the findings and take appropriate action.

A change should not be expanded merely because it has produced favorable results in another country or healthcare organization.

Implementation decisions should reflect the clinical setting, local evidence, professional responsibilities, and the organization's ability to maintain safe practice.

Patient Access and Equity Must Remain Central

Clinical decarbonization also raises questions about equity.

A lower-carbon inhaler may be more expensive or less accessible to certain patients. An alternative anesthetic technique may require specialized equipment or professional expertise unavailable in some healthcare facilities.

A medical product with favorable environmental characteristics may have a higher purchase price or an uncertain supply.

These differences matter because healthcare organizations serve people with different clinical needs, financial circumstances, and access to treatment.

An environmental initiative that increases costs for patients or reduces clinically appropriate choices may create unintended inequities.

Clinical standardization can improve quality when supported by evidence, but it should preserve appropriate professional judgment and patient-specific decisions.

For Viet Nam, lower-carbon clinical care should therefore be developed with attention to medicine and device availability, health insurance and payment arrangements, affordability, professional capability, and service accessibility.

Environmental benefits should not be pursued by shifting unacceptable costs or clinical risks onto vulnerable patients.

The most responsible opportunities are those where safe care, equitable access, and environmental improvement can be advanced together.

What the Vietnamese Healthcare Context Requires

Viet Nam has established policies concerning climate change, environmental protection, and sustainable development.

However, lower-carbon clinical care should be distinguished from national emissions reduction obligations and broader environmental reporting requirements.

A healthcare organization may have opportunities to reduce emissions from clinical activities without being legally required to substitute particular anesthetic agents, inhalers, or medical products.

Implementation capability also varies.

Large hospitals may have greater access to specialized equipment, clinical pharmacy services, professional training, and environmental data. Smaller facilities may face different constraints involving medicine availability, staffing, financial resources, and technical support.

The services provided are equally important.

A hospital with substantial surgical activity may identify opportunities related to anesthetic practice. A respiratory clinic may find inhaler selection and patient education more relevant. Another organization may have more immediate opportunities to reduce unnecessary product consumption through clinically appropriate changes in workflow.

There is no reason to assume that every healthcare facility should begin with the same intervention.

The limits of national evidence should also be recognized.

International studies provide valuable information about clinical decarbonization strategies, but they do not establish the current national carbon footprint of anesthetic practice, inhaler use, or individual clinical pathways in Viet Nam.

The Vietnamese clinical studies and educational materials discussed here provide evidence about selected aspects of patient care. They are not nationally representative studies of clinical greenhouse gas emissions.

More detailed conclusions would require appropriate facility-level or national data.

For healthcare organizations, this supports an approach based on credible evidence, local relevance, and practical evaluation rather than premature claims about the emissions reductions that can be achieved.

Applying International Guidance Within Viet Nam's Legal Framework

Clinical decarbonization in Viet Nam must remain consistent with the laws governing medical examination and treatment, pharmaceuticals, medical devices, environmental protection, and relevant professional responsibilities.

These legal frameworks are connected, but they address different activities and should not be treated as interchangeable.

The Law on Medical Examination and Treatment, No. 15/2023/QH15, effective January 1, 2024, provides an important foundation for clinical practice, professional responsibilities, and patient rights.

Any initiative involving changes to treatment must respect authorized scopes of practice, relevant professional requirements, and the clinical needs of patients.

A sustainability objective does not independently authorize a healthcare professional or organization to modify treatment outside the applicable clinical and legal framework.

Medicines and Prescribing Responsibilities

Pharmaceutical management is governed by the Law on Pharmacy, No. 105/2016/QH13, as amended, including by Law No. 44/2024/QH15, which took effect on July 1, 2025.

Government Decree No. 163/2025/ND-CP, effective July 1, 2025, provides detailed provisions for implementing the pharmaceutical legal framework.

Ministry of Health Circular No. 26/2025/TT-BYT, also effective July 1, 2025, regulates prescriptions and the prescribing of chemical medicines and biological products in outpatient treatment.

These instruments are relevant to the legal and professional conditions under which prescribing decisions are made.

They should not be interpreted as establishing a general obligation to select lower-carbon medicines or inhalers regardless of clinical suitability.

Medicine availability, registration status, prescribing requirements, and appropriate use remain subject to applicable pharmaceutical regulations and professional standards.

For products combining medicines and delivery devices, the applicable regulatory classification and requirements must be determined according to the characteristics of the product and relevant Vietnamese law. Such products should not automatically be assumed to fall entirely within either the pharmaceutical or medical device framework.

Medical Devices and Safe Product Use

Medical devices are governed by a separate regulatory framework.

Government Decree No. 98/2021/ND-CP provides principal requirements concerning medical device management and has been amended by subsequent instruments, including Decree No. 07/2023/ND-CP and Decree No. 04/2025/ND-CP.

Ministry of Health Circular No. 24/2026/TT-BYT, effective July 1, 2026, establishes provisions concerning risk determination and management measures for products classified as medical devices and amends selected implementing requirements.

These rules are relevant when healthcare organizations consider alternative medical equipment, products, or arrangements involving their use.

Environmental considerations do not replace applicable requirements concerning authorization, quality, safety, intended use, maintenance, or professional responsibilities.

Similarly, reducing waste does not automatically authorize reuse or reprocessing of a product intended for single use.

Environmental Protection and Greenhouse Gas Obligations

Environmental protection and greenhouse gas emissions are governed by another legal framework.

The Law on Environmental Protection, No. 72/2020/QH14, as amended, including by Law No. 146/2025/QH15, establishes the broader legal context.

Government Decree No. 06/2022/ND-CP regulates greenhouse gas emissions mitigation and ozone layer protection. It was subsequently amended by Decree No. 119/2025/ND-CP, effective August 1, 2025, and Decree No. 83/2026/ND-CP, effective March 23, 2026.

An important development in 2026 concerns the official list of sectors and facilities required to conduct greenhouse gas inventories.

Prime Minister's Decision No. 42/2026/QD-TTg, dated August 10, 2026, issued an updated list and took effect on September 25, 2026.

It replaced Decision No. 13/2024/QD-TTg, which ceased to have effect when the new Decision became effective.

The updated Decision also contains a transitional provision for facilities previously listed but not included in the new list, including an exemption from submitting the facility-level greenhouse gas inventory report from 2027 for the 2026 inventory period under the specified circumstances.

Healthcare organizations should therefore determine their obligations according to the current regulations and whether their particular facilities fall within the relevant categories or official lists.

These requirements should not be interpreted as meaning that every hospital or clinic in Viet Nam must automatically conduct the same mandatory greenhouse gas inventory or implement identical mitigation measures.

Even where an organization has reporting obligations, this does not independently establish a legal requirement to replace a particular anesthetic agent, inhaler, or medical product.

International guidance also requires appropriate interpretation.

WHO frameworks, IHI resources, NICE recommendations, and other professional publications can support education and quality improvement. They do not automatically become binding Vietnamese clinical protocols, prescribing requirements, environmental permits, or accreditation criteria.

Healthcare organizations should use credible international evidence while maintaining clear responsibility for compliance with Vietnamese laws and applicable professional standards.

Integrating Environmental Improvement Into Clinical Governance

Clinical decarbonization is more likely to be meaningful when it strengthens existing clinical governance and quality improvement arrangements.

Healthcare organizations already have responsibilities concerning treatment effectiveness, patient safety, medicine management, medical equipment, clinical protocols, and the monitoring of care outcomes.

Environmental considerations can be incorporated into these activities where evidence and local circumstances support doing so.

For example, an anesthesia department may review anesthetic gas consumption through its existing professional quality activities. A respiratory service may include relevant environmental information when reviewing inhaler education and device selection. A clinical department may examine avoidable product use within an established improvement program.

These activities should involve the healthcare professionals responsible for the care being delivered.

Environmental or sustainability personnel may contribute technical information about emissions, but they should not independently determine clinical treatment choices.

Similarly, clinicians should have access to appropriate technical support when evaluating environmental impacts rather than being expected to perform specialized emissions calculations outside their expertise.

Healthcare leaders can help by clarifying responsibilities, supporting multidisciplinary collaboration, and ensuring that environmental initiatives are evaluated alongside clinical outcomes.

The purpose is not necessarily to create a separate clinical decarbonization committee or certification system. It is to ensure that environmental improvement is subject to appropriate professional oversight, evidence-based decision-making, and organizational accountability.

A lower-carbon initiative should be regarded as successful only when its environmental benefits are credible and its clinical implications have been appropriately evaluated.

What Climate & Health Vietnam Can Contribute

For Climate & Health Vietnam (CHVN), lower-carbon clinical care represents an important area for evidence synthesis, professional learning, and implementation-oriented collaboration.

The subject connects environmental sustainability with healthcare quality, patient safety, clinical governance, and responsible resource use.

CHVN can contribute by examining international evidence on clinical decarbonization and explaining how environmental considerations may be incorporated into healthcare improvement without overriding professional judgment.

An important area of learning is the distinction between reducing unnecessary emissions and reducing necessary healthcare.

Another is understanding why environmental comparisons between medicines, devices, and clinical procedures require appropriate clinical and technical interpretation.

CHVN can also help healthcare professionals recognize the limitations of published carbon footprint estimates and the importance of evaluating environmental changes alongside treatment effectiveness, patient safety, and access.

Potential activities include evidence summaries, professional educational resources, case discussions, and collaboration on identifying clinically appropriate opportunities for further evaluation.

Such work may involve clinicians, pharmacists, healthcare quality professionals, patient safety specialists, researchers, environmental health professionals, and relevant technical experts.

Where appropriate, CHVN may facilitate collaboration with qualified professional or academic organizations interested in responsible clinical improvement.

These activities should remain within CHVN's actual expertise, institutional capacity, professional scope, and applicable legal boundaries.

CHVN should not present its educational resources as official WHO, IHI, or NICE clinical standards or imply endorsement by those organizations.

It should also not claim authority to approve changes to medical treatment, certify medicines or medical devices, establish mandatory clinical decarbonization requirements, or determine regulatory compliance.

Where initiatives involve clinical protocols, patient-specific treatment, medical devices, pharmaceutical decisions, or formal environmental measurement, appropriately qualified and authorized professionals or organizations should be involved.

CHVN's role is to make credible evidence more accessible, explain its relevance to healthcare in Viet Nam, and encourage informed professional learning and collaboration.

This is consistent with its broader objective of advancing climate-resilient and environmentally sustainable healthcare through evidence, quality, safety, governance, and practical implementation.

Lower-Carbon Care Must Remain Safe and Effective Care

Healthcare organizations have opportunities to reduce avoidable emissions associated with clinical activities.

Anesthetic gases, inhalers, medical products, and selected clinical processes provide examples where environmental considerations may support meaningful improvement.

However, the presence of an environmental opportunity does not automatically justify changing treatment.

A medicine should not be replaced solely because another has a lower reported carbon footprint. A clinically necessary procedure should not be withheld to reduce resource consumption. A reusable medical product should not be introduced without appropriate evidence of safety, suitability, and regulatory compliance.

For healthcare organizations in Viet Nam, progress should begin with understanding existing practices, identifying credible opportunities, involving the responsible professionals, and evaluating both clinical and environmental effects.

Some improvements may be relatively straightforward. Others may require specialist expertise, equipment, revised procedures, additional training, or more detailed monitoring.

Not every healthcare facility will have the same priorities or resources, and not every international example will be appropriate for local implementation.

The most valuable improvements are those that reduce avoidable environmental impacts while maintaining access to safe, effective, and appropriate treatment.

Ultimately, lower-carbon clinical care should not be assessed only by the amount of carbon dioxide equivalent avoided. Its credibility also depends on whether patients continue to receive the care they need, professional standards are maintained, and environmental claims are supported by reliable evidence.

Lower-carbon clinical care is not about choosing environmental performance over patient care. It is about making clinically appropriate decisions that reduce avoidable emissions while protecting treatment effectiveness, patient safety, and equitable access to healthcare.

Selected References and Policy Context

International Guidance and Evidence

World Health Organization. Operational Framework for Building Climate Resilient and Low Carbon Health Systems. November 9, 2023.

DeSmidt, B., Sampath, B., Feske-Kirby, K., and Bolender, T. Accelerating Decarbonization in Clinical Care. Institute for Healthcare Improvement. 2024.

Sasso, A., DeSmidt, B., Sampath, B., Bamel, D., and Tandon, S. Getting Started with Clinical Decarbonization. Institute for Healthcare Improvement. 2025.

World Health Organization. Measuring Greenhouse Gas Emissions in Health Systems. December 22, 2025.

World Health Organization. Indicators of Climate Resilience and GHG Emissions in Health Systems. March 11, 2026.

National Institute for Health and Care Excellence, British Thoracic Society, and Scottish Intercollegiate Guidelines Network. Asthma: Diagnosis, Monitoring and Chronic Asthma Management. NICE Guideline NG245. November 2024, as updated.

Wurzel, D. F., Montgomery, B. D., et al. Environmental Impact of Inhaled Medicines: A Thoracic Society of Australia and New Zealand Position Statement. Respirology. 2025;30(2):101–112.

Verlis, K. M., Kazda, L., Barratt, A. L., et al. Interventions to Reduce Desflurane Use in Hospitals: A Systematic Review. Anaesthesia and Intensive Care. Published online October 9, 2026.

Sutin, K. M., Jain, S., Gajic, Z. Z., et al. System-Level Reduction in Anesthetic Greenhouse Gas Emissions: Central Nitrous Oxide Deactivation, Clinical Decision Support, and Secular Change in a Multicenter Interrupted Time-Series Study. Anesthesia & Analgesia. Published online September 28, 2026.

Greenhouse Gas Protocol. Corporate Accounting and Reporting Standard; Corporate Value Chain (Scope 3) Accounting and Reporting Standard; Product Life Cycle Accounting and Reporting Standard.

Selected Clinical Evidence and Professional Context From Viet Nam

Nguyen, N. H., Ngo, V. H., Nguyen, X. A., Nguyen, M. T., Nguyen, T. D., and Nguyen, T. M. H. Comparison of Recovery Quality Between Desflurane and Sevoflurane in Patients Undergoing Percutaneous Nephrolithotomy at Tam Anh General Hospital in 2026. Vietnam Medical Journal. Volume 566, Special Issue. October 6, 2026.

Gia Dinh People's Hospital. Inhaled Medicines for Asthma and Chronic Obstructive Pulmonary Disease: Correct Use Is Essential for Effective Treatment. July 27, 2026.

Viet Nam Legal, Policy, and Regulatory Context

National Assembly. Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as applicable.

National Assembly. Law on Pharmacy No. 105/2016/QH13, effective January 1, 2017, as amended.

National Assembly. Law No. 44/2024/QH15, dated November 21, 2024, amending and supplementing the Law on Pharmacy, effective July 1, 2025.

Government. Decree No. 163/2025/ND-CP, dated June 29, 2025, detailing certain provisions and implementation measures for the Law on Pharmacy, effective July 1, 2025.

Ministry of Health. Circular No. 26/2025/TT-BYT, dated June 30, 2025, regulating prescriptions and prescribing chemical medicines and biological products in outpatient treatment, effective July 1, 2025.

Government. Decree No. 98/2021/ND-CP, dated November 8, 2021, concerning medical device management, as amended by applicable subsequent instruments.

Government. Decree No. 07/2023/ND-CP, dated March 3, 2023, amending provisions of Decree No. 98/2021/ND-CP.

Government. Decree No. 04/2025/ND-CP, dated January 1, 2025, further amending provisions concerning medical device management.

Ministry of Health. Circular No. 24/2026/TT-BYT, dated June 30, 2026, concerning risk determination and management measures for medical devices and amendments to related implementing provisions, effective July 1, 2026.

National Assembly. Law on Environmental Protection No. 72/2020/QH14, effective January 1, 2022, as amended.

National Assembly. Law No. 146/2025/QH15, dated December 11, 2025, amending selected provisions of laws in the agriculture and environment sectors, including the Law on Environmental Protection, effective January 1, 2026.

Government. Decree No. 06/2022/ND-CP, dated January 7, 2022, concerning greenhouse gas emissions mitigation and ozone layer protection, as amended.

Government. Decree No. 119/2025/ND-CP, dated June 9, 2025, amending provisions of Decree No. 06/2022/ND-CP, effective August 1, 2025.

Government. Decree No. 83/2026/ND-CP, dated March 23, 2026, further amending provisions of Decree No. 06/2022/ND-CP, effective March 23, 2026.

Prime Minister of Viet Nam. Decision No. 42/2026/QD-TTg, dated August 10, 2026, issuing the updated list of sectors and facilities required to conduct greenhouse gas inventories, effective September 25, 2026, replacing Decision No. 13/2024/QD-TTg.

Professional scope: This article is intended for professional education, evidence synthesis, and knowledge sharing. It does not constitute individualized clinical advice, prescribing guidance, anesthetic technique instructions, medical device authorization, pharmaceutical or medical device regulatory advice, a facility-specific greenhouse gas assessment, legal advice, an official WHO or IHI assessment, or accreditation or certification criteria. References to clinical decarbonization strategies are illustrative and should not be interpreted as recommendations to substitute medicines, modify anesthetic techniques, reuse medical devices, reduce necessary healthcare services, or change patient treatment without appropriate professional assessment. References to WHO, IHI, NICE, and other international organizations do not imply endorsement of Climate & Health Vietnam or its activities. Healthcare organizations should apply current Vietnamese laws, applicable professional requirements, relevant clinical guidance, and qualified clinical, pharmaceutical, medical device, quality improvement, patient safety, environmental, and organizational judgment when evaluating or implementing lower-carbon clinical care initiatives.