RESUMO
The link between environment and health has been well established, as has the need to develop strategies to manage the environment to protect health. The response of many governments to the emergence of environment as a leading concern of public health policy has been to fragment environment and health functions across many agencies, without effective coordination or communication systems, resulting in poor planning frameworks. There is a deepening awareness by many in government and international agencies of the need to develop 'national environmental health plans' (NEHAPS) to build and integrate environment and health policy and practice. To date, however, experience in the development of these and similar plans indicates that prescriptive 'top-down' approaches to plan development may yield limited success. This paper describes an ongoing project in Vietnam to develop a process for a national environmental health plan that provides a strong link between policies and practice, and utilizes a learning model for plan development. As environmental health is a new concept in Vietnam, significant attention has been given to the development of both national and local visions. The lessons learnt to date indicate that the use of a learning framework may provide a strong basis for the emergence of environmental health policy and its management. Facilitation of this process has required the use of a variety of change management tools and has placed an emphasis on using them in culturally sensitive ways. It is hoped that the emerging model, which gives environmental health its first expression at both national and provincial levels, will be of value to others undertaking similar policy and planning initiatives.
