Enhancing self-care and access - The Dutch stepped care model to strategically organize public sexual health for young people.

Public Sexual and Reproductive Health (SRH) services are traditionally provided face-to-face by Dutch Sexual Healthcare Clinics. High demand for these services led to the exploration of digital health to increase access and support self-care. However, the implementation was fragmented and uncoordinated. Therefore, the Stepped Care Model (SCM) was introduced to (1) organize coordination and cooperation between regional and national providers of public SRH-services for young people; (2) link digital services to clinical services and identify opportunities for new digital services; (3) increase the accessibility of SRH-services; and (4) stimulate self-care. This article describes the Dutch SCM and how digital health is integrated The process started by identifying key stakeholders and promoting collaboration followed by development and implementation of an unified national online platform to access comprehensive SRH services. The different levels of care of the existing services were categorized and overlap between services were inventoried. Based on 'ideal client journeys' for different sexual health themes, relevant services on different care levels were linked to each other and new opportunities for digital or combined digital-professional supported services were identified. It is explained how young people can gain easy access to increasingly specific and specialist services at the higher steps of the model via the online central portal with general information as a first step. The lessons learned highlight the importance of partnerships, coordination and a shared strategy leading to reduced fragmentation and increased accessibility of services and more self-care. The constraints of the Dutch SCM are related to restricted evaluation possibilities due to anonymized client data, limited target group involvement, complexity of digital service development along with possible resistance from health professionals. The SCM shows how efficiency in health systems can be achieved following the principle of economies of scale: more coordination and less fragmentation, leading to lower costs for development and implementation of digital services, availability and bundling of specialized technical and regulatory expertise and financial resources, ultimately leading to reduced waiting times and more self-care for young people.