[Developing a heuristic Transformative Health Governance model from an evaluation of the Dutch All about Health program].

Introduction: By evaluating the Dutch national program All about Health (AiG) for facilitating cross-domain societal health networks, we investigate the question 'How can societal health transformation be conceptualized and evaluated?' Using literature, progress in these networks has been interpreted as a chain of small wins resulting from situational, action-oriented, and transformational change mechanisms of contextual preconditions. Methods: Between 2014 and 2022, a multiple case study was conducted with four different initiative networks affiliated with AiG, involving a total of 53 semi-structured stakeholder interviews, fifteen observations of network meetings, training sessions, and local workshops, and validating insights in three dialogue workshops with pioneers and AiG staff. Results: Observations led to the formulation of five small wins and five change mechanisms that mutually reinforce each other in a non-linear way, driven by a national platform facilitated by the AiG program office. Conflict escalation and management are of essential importance for the adaptation or revision of norms, practices and underlying rules and responsibilities. These gains and mechanisms have been brought together in a heuristic Transformative Health Governance Model. Conclusion: Societal health transformation calls for a transition within policy systems towards demand-driven policy and a transformation towards shared responsibilities between policy systems as well as between the state, the market, and society. The THG model offers an evaluative framework and an action perspective to health transformation initiatives in society. More research is required to understand and achieve a translation of normative transformation into institutional transformation.