87 Monitoring the Dutch Solid Start program: developing an indicator set for municipalities INTRODUCTION Reducing perinatal health inequities and improving health outcomes for parents and children are high on the Dutch policy agenda since the early 2000s. Following alarming perinatal mortality and morbidity figures (1, 2), several policy measures were taken to improve maternity care, including the establishment of maternity care networks (3), experiments with bundled payment for maternity care (4) and the development of the ‘Standard for Integrated Birth Care’ (5). Over the years, the focus of the programs shifted from the medical sector more towards the social and public health care sector, as perinatal and maternal health is strongly influenced by the wider social, economic and cultural contexts of families (6, 7). For instance, a regional cross-sectoral approach to perinatal and maternal health, integrating the medical and social sector, was taken in the local ‘Ready for a baby’ program (8) and subsequent ‘Healthy Pregnancy 4-All’ programs (9-11). These programs laid the foundation for the nationwide ‘Solid Start’ action program. The Solid Start program was launched by the Dutch Ministry of Health, Welfare and Sport in September 2018 with the aim to give every child the best start in life by focusing on the first thousand days (12). This period from preconception to the child’s second birthday is crucial for children’s further physical, mental and social development and is therefore regarded as a window of opportunity to improve population health (6, 13, 14). The integrated approach of the Solid Start program combines medical and social services to offer better support during the first thousand days, specifically for parents in vulnerable situations. Consequently, the scope of integrated service delivery within the program is not limited to the health sector alone, but rather expanded to coordinate care and support also between the health and social sector (including public health) with its various organizations and providers (among which midwives, social workers, gynaecologists, youth healthcare providers, debt counsellors, and municipal officials). The Solid Start program is conceptualized and implemented over three phases: before pregnancy, during pregnancy and after birth (up to two years). Municipalities receive additional subsidies from the Ministry of Health to form local coalitions of partners within the medical and social sector, in order to tackle the region-specific challenges. Examples of region-specific challenges are unintended pregnancies, housing problems, domestic violence, and loneliness. This approach fits with the decentralization tendencies of social care in the Netherlands. Since 2015, the government has given municipalities new responsibilities in youth care, longterm care and income support, which cause local differences in policy implementation and outcomes (15). Next to the subsidies, supportive methods were developed and offered to local coalitions. Examples include an analysis tool to map the current and desired situation and an overview of effective interventions (e.g. prenatal home visits and ‘Centering Pregnancy™’: group care during pregnancy). Moreover, local coalitions receive support to develop and implement their local coalition and related programs by Pharos, which is the Dutch Centre of Expertise on Health Disparities. The Ministry of Health commissioned the National Institute for Public Health and the Environment (Dutch abbreviation: RIVM) to monitor the implementation of the Solid 4
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