Small wins for long-term health governance: Dynamics in the Dutch Physical Activity Network Alliance

Amid growing policy and scientific calls to place prevention and wellbeing at the center of health systems, national governments are experimenting with collaborative governance platforms - structures that facilitate and coordinate multiple collaborations – as instruments for systemic change. Yet the practical dynamics of how such platforms generate and connect incremental progress to long-term change remain underexplored. This study investigates how small wins emerge, accumulate, and are valued within the Dutch collaborative governance platform “Physical Activity Network Alliance”. This study uses a process-tracing approach across three thematic networks (“circles”) focused on movement-friendly environments. Our findings show that mechanisms of (1) generating ideas for thematic networks, (2) mobilizing partners from within and outside the physical activity sector, and (3) experimenting with new approaches to promote physical activity, unfold in non-linear and iterative ways. Mechanisms are shaped by both the platform’s organizational capacity and its connective, inclusive approach. Temporal pressures and funding uncertainties often stimulate a focus on short-term, concrete results, sometimes at the expense of broader experimentation and long-term ambition. The study also emphasizes counterfactuals and tensions that can hinder the accumulation of small wins, such as repeated plan revisions, administrative demands, and mismatches in working tempos. These dynamics reveal that small wins are fragile and contingent, requiring ongoing negotiation, adaptive facilitation, and an awareness of the broader context in which collaboration unfolds. By empirically tracing these processes, this study bridges theoretical models and real-world complexities, offering actionable insights for the design and management of collaborative health governance platforms.

Key messages

• Cross-sectoral networks provide space to experiment with new ways to promote physical activity - small steps now, but with potential for long-term, transformative impact.

• Collaborative governance platforms must balance sustaining bottom-up energy with building structure to integrate collaborations toward long-term, systemic change.