The objective of this study was to identify the needs for and solutions to pesticide risk reduction for farmers in Vietnam, using a comprehensive needs assessment model applied for evaluating community needs and policy development. Four kinds of needs were evaluated using qualitative research methods. A comparative analysis of pesticide regulations was used to identify comparative needs. In-depth interviews with authorities and experts were conducted to identify normative needs. Observations on farmer's practice were used to identify expressed needs, and focus group discussions among farmers were implemented to identify felt needs. The needs for pesticide regulations obtained from comparative analysis and experts include enhancement of pesticide legislation; multisectoral involvement in pesticide regulations; improvement of capacity for sectors involving in pesticide regulations; risk-benefit guidance for pesticide registration; reforms of pesticide regulations relating to the restriction, cancellation, suspension, transport, storage, and disposal of pesticides; and the development of occupational hygiene and safety policy and programs for agricultural activities. The expressed needs based on field observations comprise improvement in knowledge and behavior of farmers about pesticide safety with specific areas, and supports in safety facilities and personal protective equipment. The key request from farmers include needs about technical training for occupational safety and hygiene of pesticide application, and support for safety facilities for pesticide application and protective equipment. The results of comprehensive needs assessment were useful in the development of a range of strategies in legislative improvement, workplace and personal hygiene, information and training, and medical surveillance and pesticide poisoning first aids for pesticide risk reduction for Vietnamese farmers.