138 CHAPTER 5 uncertain and may not always benefit the investor (wrong pocket issue). Over the years, but peaking in 2021, stakeholders have called for structural and sustainable funding to ensure Solid Start’s sustainability. Next, stakeholders noted increased involvement of organizations and professionals from the medical and social sector. The composition of coalitions varied based on factors such as the municipalities’ focus, challenges and historical context. General practitioners, health insurers and experts-by-experience were mentioned as major missing parties. Stakeholders anticipated that GPs, who are potentially vital in preconception care, were often unavailable due to their heavy workload and because they did not view Solid Start as a core activity. Health insurers were seen as a potential source of funding for preventive activities, although discussions about this were experienced as difficult due to the health insurers’ focus on individuals (indicated prevention) rather than on groups (universal or selective prevention). Moreover, stakeholders mentioned several laws and regulations that hindered crosssectoral collaboration. One example concerned the legal task of youth healthcare to enhance children’s health and development (0 – 18 years), which lacks a focus on pregnancy and (future) parents. At the time of data collection, a law was being prepared that gave municipalities the responsibility to implement prenatal home visits by youth healthcare. This expands the scope of youth healthcare and was well-received. Another example was the ambiguity of midwives’ role in promoting preconception health, as they usually meet expectant mothers during pregnancy. Several stakeholders called for better preconception care arrangements. Lastly, when other crises were perceived as more immediate (e.g. COVID-19 pandemic for Public Health Services), organizations tend to focus on their core activities written in laws and regulations, which may not always include Solid Start. Hence, stakeholders expressed a need to adapt the scope of laws and regulations to facilitate Solid Start. Additionally, they mentioned that well-defined procedures, roles and responsibilities could help to eliminate a lack of commitment. They suggested for example that an organizational entity should be allocated with the responsibility to serve as the driving force to continue with Solid Start, even if funding by the Ministry of Health, Welfare and Sport would stop. Stakeholders appreciated the national Solid Start program’s design and structure, which features national governmental stewardship and a strong local focus and infrastructure. They acknowledged that the program’s emphasis on local considerations was appropriate, given the unique contextual and societal challenges faced by different municipalities. The program provided sufficient autonomy to implement locally without following a rigid, prescriptive checklist. However, stakeholders also sought to ensure the institutionalization and long-term integration of Solid Start and its interventions. Municipalities reported difficulties in moving out of the innovation- and pilot-phase. Stakeholders emphasized, especially in 2021, that they considered Solid Start a ‘transition’ or ‘movement’ rather than a short-term project. Although progress was being made, stakeholders recognized
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