Pangasius farm smallholders in Vietnam have to deal with a lot of problems in their production process. Difficulties in disease management are perceived because of the BNP disease. Global markets stringent quality standards hinder the smallholders to participate in the export chain. Food safety, including health risks, antibiotic residues and microbial pathogens such as parasites are part of the quality standards which are becoming more severe. Antibiotic resistance is a serious problem for human global health and therefore antibiotics should be used in a responsible way. Smallholders face difficulties to control and assure quality for the export market because the disease management lacks traceability. This paper focuses on the current disease prevention and treatment knowledge of small Pangasius farming and farmers' willingness to implement new farming systems to manage diseases and take a needed step in assuring their disease management quality. Using qualitative as well as quantitative data gained during a field research in Vietnam, farmers' current and needed disease management standards are compared to measure if there is a knowledge gap. Farmers 'organisation and the extension system are examined to see how knowledge is managed by stakeholders. Results show that small farmers have a lot of knowledge about disease management but they do not have the willingness and possibilities to adapt every quality control standard. Implementation of Better Managment Practices combined with clusters is recommended to give farmers the opportunity to survive the export market. Though not all farmers can form clusters, it seems to be the only way for smallholders to get certified. The government has to be willing to support farmers by providing access to capital and by creating farmer awareness of the benefits. It is unlikely that farmers are willing to change without the support of stakeholders