137 Implementation and experiences of the Solid Start program Functional integration Pharos has supported municipalities since 2019 in building their coalition, which was highly valued. Municipalities had varying needs for support, depending on the coalitions’ developmental stage and other factors. The need for one-on-one support seemed to have shifted towards a need for mutual knowledge-exchange over time. As previously explained, stakeholders requested additional support for professionals to incorporate Solid Start into everyday practice. A participant in a FGD said: “Ultimately, you do it for the children and their parents, but you need to give the professionals tools to be able to continue to do this.” - FGD, 2021 The FGDs revealed difficulties in sharing information between professionals, particularly in the context of referrals. This was complicated by General Data Protection Regulations according to the stakeholders. Some stakeholders called for an integrated information system and more transparency. Although digital data exchange in birth care has been in development for a few years, it was not yet standard practice. System integration We have found several systemic determinants that influenced collaboration at meso- and microlevel. Overall, most challenges that arose in the interviews and FGDs seemed to concern systemic integration. Hence, stakeholders highlighted a range of needs that should be addressed in order to embed Solid Start and ensure the program’s sustainability. One of the stakeholders explained her view, which was supported by many others: “It is really a transition from the system as it was, you know, quite a fragmented system. […] Even four years is very short for that, right? So you’re really setting a movement in motion, and I think that program is really setting that in motion. But it is really a long-term issue, simply because you are changing a lot of things. [...] When you really want to get it into the system, and therefore want to see improvements in collaboration everywhere, then these annoying prerequisites come up again, right? Then you have to make sure that financing follows as well, that it supports care instead of getting in the way, for example. Those kind of things.” - FGD, 2021 In relation to available resources, stakeholders mentioned that the Solid Start funds helped to start activities at local level. However, the funds were frequently described as limited, temporary and project-oriented, thereby impeding long-term planning. Municipalities reported difficulties to obtain funds for interventions, and to bring partners together without reimbursements. Stakeholders noted that funds were often invested in innovation and curation rather than implementation and prevention. Moreover, they generally mentioned unclarity regarding prevention. For various preventive activities related to Solid Start, it was unclear to the stakeholders whether the municipality or health insurers should bear the financial responsibility, resulting in occasions where funds were unavailable. There are five different Dutch laws that include prevention, which complicated the financing and funding thereof. Another difficulty was that investing in preventive measures can be 5
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