Coordinating healthcare pathway

Context: Since 2019, the French government has been implementing a new coordination structure, the maison sport-santé (literally, it means physical activity for health center). This public policy is aimed at people who are not practicing enough physical activity and at patients suffering from chronic illness. Beneficiaries are offered a personalized program designed to help them re-engage in physical activity over a long term period. The maison sport-santé is designed to interact and coordinate sports, social and health organisations and professionals, to offer a global and integrated health approach to users. Method: A qualitative approach was adopted to investigate the issues involved in coordinating physical activity pathway, and thus coordinating social actors from the field of sports, health and social. The aim of this work is to analyse a public policy through a micro-level perspective, in order to gain a detailed understanding of its practical implementation. Furhermore, it studies the way in which the maison sport-santé develop strategies to create cooperation and coordination based on an integrated and personalized health pathway for the user. Over a two-year period, non-participant observations and 34 semi-structured interviews were conducted. Three monographs of different structures were also carried out. Analysis of meeting reports and official documents contextualised the interviews and observations. Results: Although the maison sport-santé are tasked with coordinating the physical activity pathway, it turns out that they are more cooperating with their partners on small projects rather than fully coordinating all the social actors. As a result, these structures have difficulty gaining recognition as the legitimate central organisation in the field of physical activity for health. They face numerous professional struggles and organisational conflicts. The maison sport-santé produce a narrative based on the common good and service user to encourage cooperation between social actors, to regulate conflicts and the work of their service providers. This form of coordination directly calls into question the organisation of work in the field of health and its components, i.e. the social sector and physical activity. The budgetary and human resources constraints faced by the maison sport-santé vary according to their social network and the support they receive from local policies. Discussion: This study analyses the local implementing of a public health measure through the perspective of meanings produced by local actors and of collective action. It brings some insights about the local implementation of a people-centred policy. If this research focused on the main social actors of the public policy (the local government, the maison sport-santé and their partners), it would be interesting to extend the analysis to all social actors in the ecological systems (professional associations, sports federations, etc.). In addition, the analysis of the actions organised around the maisons sport-santé reveals trends in the way public health policies are governed. It would be useful to develop an analysis of the transfer of a public service to local, sometimes private organisations. These points of improvement are currently being pursued as part of a thesis within the EHESP doctoral network in public health.