Despite having a sophisticated health-care system and spending more on health care than do most countries in the world, by the early 2010s the Netherlands experienced some of the poorest perinatal-health outcomes in the European Union. Birth-related complications among women and infants were driven primarily by economic and social inequality. For example, women living in the country’s low-income neighborhoods were up to four times more likely to die during childbirth than the Dutch average. In partnership with university researchers, the municipalities of Rotterdam, Groningen, and Tilburg began tackling the problem. After discovering that the growing disparities in perinatal health outcomes were driven in large part by social and economic challenges rather than by purely medical factors, the cities set out to build integrated, multisectoral teams­—local coalitions—that brought together service providers working in both the health-care and social domains. To tailor care to an individual patient’s own circumstances, the coalitions transcended the traditional boundaries that separated physicians, midwives, municipal officials, social workers, and other service providers. They worked to integrate their records and come to agreement on ways to monitor progress, and they designed referral systems and procedural road maps to deal with specific and individual client problems. In 2018, the national Ministry of Health, Welfare and Sport expanded the use of such local coalitions to reduce early-childhood health disparities in municipalities throughout the country. By early 2022, 275 of the Netherlands’ 345 municipalities were participating in the program, dubbed Solid Start, and the new national government pledged to expand the program to every municipality in the country.

Leon Schreiber drafted this case study based on interviews conducted between September 2021 and April 2022. Case published May 2022. This case study was supported by Bernard van Leer Foundation as part of a policy learning initiative. Please note that the Solid Start program described in the case is not an instance of the foundation’s Urban95 strategy, which features in several other ISS case studies that are part of the learning project.

Jorge Muñoz had long championed efforts to improve the lives of children in his relatively well-off district of Peru’s capital city, Lima. In 2019, he had a chance to take some of his ideas to scale. As newly elected mayor of metropolitan Lima, a city of almost 11 million, he oversaw basic services for about a third of the country’s population. At the time, a fifth of Peru’s population lived in poverty, and one in three people lived in informal settlements, where supporting families to give infants and toddlers a healthy start on life presented many challenges. The mayor directed the metropolitan government’s Social Development Department and a small interdisciplinary team of architects and social scientists (1) to identify lessons learned from pilot projects, (2) to establish new ways of assisting infants and young children, and (3) to coordinate to get the job done. When the COVID-19 pandemic broke out in the capital city in 2020, the metropolitan government and its team continued this work, using some of their newly created systems to respond to the larger challenge of caring for vulnerable populations during months of emergency lockdown measures. The national government labeled Lima’s program, which engaged residents in project development, as a promising model for helping local governments implement a countrywide strategy for the promotion of early childhood development.

Miguelángel Verde drafted this case study with the help of Tyler McBrien based on interviews conducted in Lima, Peru, during 2020 and 2021. Case published August 2021. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

By the mid-2010s, Istanbul, the biggest city in Turkey, had developed a reputation as a bustling concrete jungle notoriously unfriendly to the 1.2 million children aged four years and younger who lived there. As part of a decade-long construction boom, multistory skyscrapers increasingly replaced green spaces and parks throughout the city. But such insufficient consideration for the developmental needs of young children was not confined to the design of public and urban spaces: in many Istanbul homes, parents worked hard to put food on the table and had little time to consider how to give their young children the best possible start in life. In February 2016, a coalition of policy research organizations and private enterprises launched an ambitious effort to persuade officials in Istanbul’s 39 districts to begin taking the needs of young children seriously. The group drew on help from a network of prominent Turkish universities and partnered with four district municipalities that agreed to join a program called Istanbul95, supported by the Bernard van Leer Foundation, a Dutch foundation. The group created a digital-mapping tool to help locate vulnerable children, conducted regular home visits to support hundreds of families, and designed new prototypes for child-friendly public spaces. This effort to embed principles of early childhood development into the work of Turkish local governments passed a milestone when, in 2019, the major metropolitan area governments of Istanbul and İzmir also agreed to join, a key step toward reaching many more children.

Leon Schreiber and Gordon LaForge drafted this case study based on interviews conducted in Istanbul in June and July 2020. Case published November 2020. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.