158 CHAPTER 6 nationwide implementation versus facilitating the local monitoring and approach. In the local monitoring of the action program Solid Start, the indicator set can enhance the conversation between policymakers, managers, professionals and other stakeholders about the local situation and developments to prioritize local interventions and policies. What are the developments and experiences with the action program Solid Start and specifically cross-sectoral collaboration? Chapter 5 describes the implementation of the action program Solid Start during the program’s own first thousand days (i.e. 2019, 2020 and 2021), with a specific focus on cross-sectoral collaboration. Generally, the findings from questionnaires, focus group discussions and interviews revealed progress in collaboration at different levels over the years. First, the study reflected on the development of local coalitions Solid Start. We found a growing number of coalitions Solid Start involving diverse stakeholders, and municipalities increasingly reported plans of action, objectives, ambitions and activities for Solid Start. Coalition development varied due to municipalities’ unique challenges, focus and historical contexts. Secondly, our results provided insight into the experiences with the action program Solid Start and cross-sectoral collaboration, including facilitators, barriers and needs. Initiating the action program Solid Start increased the sense of urgency for the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements and protocols on cross-sectoral care provision. Some general facilitators for effective coalitions Solid Start were an active coordinator as a driving force and a shared societal goal. Moreover, stakeholders appreciated the program’s strong local focus and opportunities for learning. However, the action program Solid Start appeared not yet fully incorporated into all professionals’ everyday practice. Most common barriers related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of continuing with Solid Start and suggested various needs to ensure the program’s sustainability. Those needs included sustainable funding, supportive regulations, ongoing knowledge development and learning, responsiveness to stakeholders’ needs, and better and more client involvement. REFLECTION The action program Solid Start is the first national program to address the full period of the first thousand days while bridging the medical and social sector. The elements of the action program Solid Start were increasingly adopted over the past years, reflecting a shift from traditional, fragmented care towards a more integrated, population healthbased care system (6). The approach emphasizes prevention and acknowledges the social determinants of health, which are favoured but still sporadic elements of integrated care models (7). In this thesis, integrated care denotes the collaborative efforts of professionals and organizations across the medical and social sector to provide comprehensive, accessible and coordinated care for the benefit of (future) parents and their children (8, 9).
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