13 General introduction action program ‘Solid Start’ was launched by the Dutch Ministry of Health, Welfare, and Sport (Dutch abbreviation: VWS) to ensure that every child receives the best possible start during the first thousand days of life (83). It promotes collaborative efforts across the medical and social sector and focuses particularly on (future) parents and young children in vulnerable situations. The action program’s strategic framework is built upon previous endeavours aimed at integrating medical and social services, such as the local ‘Ready for a baby’ program in Rotterdam (2008–2012) (84) and subsequent ‘Healthy Pregnancy 4-All’ programs implemented in various municipalities since 2011 (28, 62, 85). It is part of a wider movement in Dutch maternity care, which developed from a narrow focus to the mother’s health during childbirth, to a more social and cross-sectoral approach for (future) parents and children in which pregnancy and early childhood is considered a window of opportunity to address health inequities and enhance overall well-being (63). Several key moments catalysed this movement. For example, the European Peristat reports showed relatively high perinatal mortality rates in 2004 and 2008 (86, 87) which created momentum for a cascade of activities (88). Activities including the establishments of maternity care networks in which midwives, gynaecologists and other maternity care providers collaborate (89), experiments with bundled payment (90) and the initiation of the Standard for Integrated Maternity Care (91). The action program Solid Start employs a comprehensive and population-based strategy (83). It is conceptualized and implemented across three pillars: before pregnancy, during pregnancy, and after birth. At the start of the action program Solid Start, several aims were set, summarized as follows: prevent unintended pregnancies, prepare parents better for pregnancy, identify medical and non-medical issues earlier, and offer tailored support for (future) parents in vulnerable situations. The preventive and supportive measures aim to address the underlying determinants of health and well-being from an early stage, to prevent or mitigate health-related issues that may arise later in life. The program’s backbone is the stimulation of cross-sectoral collaboration through local coalitions Solid Start. Municipalities are vital in creating local coalitions Solid Start, consisting of organizations and service providers spanning the medical, social and public health domain. Involved stakeholders can include midwives, obstetricians, maternity care assistants, youth healthcare providers, social workers, debt counsellors, municipal officials, experts-by-experience. Municipalities are stimulated to create their own approach that fits their local context, challenges and existing networks. Since the decentralization in 2015, municipalities were already given new responsibilities in youth care, long-term care and income-support that fuelled differences in their approach and services (92). Municipalities received financial support from the Ministry of Health, Welfare and Sport, and they were provided assistance in building or strengthening their coalition from Pharos, the Dutch Centre of Expertise on Health Disparities (93). Pharos’ advisors have one-on-one meetings with municipalities, but the organization also provides shared training, webinars and informative webpages. Other support for local coalitions Solid Start included the availability of an analysis tool, data, a list of effective interventions and care pathways. Moreover, the Ministry of Health, Welfare and Sport facilitates and stimulates the action program Solid Start by striving for legal changes. Part of the action program also 1
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