Purpose: Ensure SCI is not treated as a standalone project logic but embedded into how policies, strategies, and plans are designed, funded, and reviewed, and anchored in the mandates of multiple sectors, not only health.

What tends to work:
 Identify the policy cycles that already shape decisions in your context, such as local development plans, health and wellbeing strategies, social inclusion plans, education strategies, climate or urban plans, or national reform programmes, and map where prevention and health promotion objectives already appear, even implicitly.

Aligning with existing policy frameworks significantly reduces resistance and accelerates progress. The Invest4Health Wales testbed illustrated this well: when the Welsh Government released a national social prescribing framework in 2023, the testbed was able to align its goals with national policy, giving it institutional legitimacy and a clearer path forward. Before that alignment, progress had been slower.

Once you have identified relevant policy entry points, clarify which objectives your initiative contributes to beyond health such as employment, educational attainment, social cohesion, urban regeneration, or environmental sustainability and explicitly link these outcomes to the mandates of the responsible departments or organisations. The Invest4Health testbed experience consistently showed that engaging decision-makers across sectors is one of the hardest and most critical steps. In Skåne, while municipalities were actively engaged, securing longer-term commitment from regional decision-makers on shared governance proved difficult. In North Rhine-Westphalia, employers and insurers expressed interest but hesitated to commit without clearer evidence, defined responsibilities, and pre-existing solutions. The lesson is that cross-sector alignment requires more than goodwill; it requires explicitly connecting your initiative to what each sector is already mandated and incentivised to do.

At local or organisational level, this may involve integrating SCI principles into strategy documents and budget proposals, or convening cross-departmental working groups to identify shared goals and co-benefits. At regional or national level, it means embedding SCI into inter-ministerial strategies supported by formal coordination mechanisms, shared outcome indicators, and medium-term expenditure frameworks so that prevention investments are reviewed alongside other public investments

Purpose: Move SCI from time-limited or pilot funding into routine financial and commissioning systems.

What tends to work:
Review existing funding streams, commissioning rules, relevant legislation, and budget structures to identify where prevention investments are constrained by short-term or siloed funding. The Invest4Health testbed experience showed that reallocation of existing public resources is often the most realistic and lowest-friction starting point. In Wales, pooling three separately managed programmes under shared governance, without creating new money, has been adopted into routine practice. More complex models, such as outcome-based financing or blended public-private investment, are worth exploring but require greater institutional readiness, clearer governance, and more time than a project setting typically allows. At regional or national level, adapt procurement, grant programmes, or reimbursement systems to allow outcome-based payments or co-investment models where feasible. Wherever possible, link SCI to existing funding instruments rather than creating entirely new mechanisms.

Purpose: Ensure organisations and governments have the skills, structures, and authority to design, manage, and scale SCI over time.

What tends to work:
The Invest4Health testbed experience makes one lesson particularly clear: governance and capacity-building cannot be left until implementation is underway. In Galicia, leadership changes within the regional health authority caused significant delays because the governance conditions were not yet sufficiently embedded. In Skåne, the testbed found that building shared governance infrastructure including stakeholder mapping, readiness gap analysis, collaborative platforms, had to precede rather than follow the financing conversation.

The practical implication is to invest early in three things: a shared and accessible definition of what SCI means in your context; clear governance arrangements defining who decides, who pays, who monitors, and who is accountable; and designated individuals or teams with explicit responsibility for coordination and continuity.

Closely related to governance is the question of ownership. Initiatives that successfully sustain themselves almost always have at least one individual or organisation with a genuine stake in the survival of what has been built, the capability to keep developing it, and the relationships to advocate for its continuation. This ownership needs to be named and nurtured during the initiative itself, not assumed to emerge afterwards. Equally important is a transition facilitator: someone with enough mandate, relationships, and institutional memory to hold the process together across sector boundaries and funding cycles.

Alongside governance and ownership, invest deliberately in capacity-building across sectors. The testbed experience consistently shows that staff at all levels, from project coordinators to senior decision-makers, need practical support to understand investment logic, design outcome frameworks, navigate cross-sector collaboration, and engage with unfamiliar financing instruments.

At higher levels, establish permanent coordination units or steering bodies and ensure these structures are protected from political and funding cycles.

Purpose: Avoid successful SCI initiatives remaining isolated or temporary, and ensure SCI becomes part of how the system operates, not just a tool applied in specific circumstances.

What tends to work:

From the outset, define what “success at scale” would mean in your context and which institutions would need to adopt or fund the intervention long term. The Invest4Health testbed experience reveals a structural gap here: in a project setting, stakeholders contribute without firm commitments to act as receivers of project results or to continue the work after funding ends. This must be addressed deliberately and early, not at the final project stage. Explicit transition plans from project funding to routine financing are essential to ensure that prevention initiatives become part of the system rather than exceptions to it.

Ultimately, the most durable pathway to sustained adoption is embedding SCI not as a named programme but as a governing principle, a way of thinking about prevention that informs how decisions are made and investments are appraised across sectors. What matters is not the terminology but the underlying logic: long-term value creation, cross-sector benefits, shared risk, and equity becoming part of how public institutions plan, budget, and account for their decisions. When that happens, health promotion and disease prevention are more likely to be sustained and scaled — not as an initiative, but as a way of governing.

Purpose: Ensure that scaling decisions are based on learning and credibility, not only advocacy.

What tends to work:

Embed evaluation requirements into funding and policy frameworks from the outset, focusing on decision-relevant evidence rather than overly complex studies. The Invest4Health testbed experience highlights a recurring tension: the outcomes that matter most, like improvements in child health, reductions in hospital admissions, long-term cost savings, take years to materialise, while funding cycles demand results much sooner. The practical response is to develop a layered outcome framework that tracks engagement and process indicators in the short term, intermediate outcomes in the medium term, and broader impact over time. In Wales, the team worked with health economists to develop predictive economic modelling of risk factors, allowing the project to demonstrate potential long-term savings without waiting decades for longitudinal data.

Use evaluation results actively in policy reviews, budget negotiations, and strategy updates. Transparent use of evidence, including acknowledging what did not work, builds credibility with funders and decision-makers over time.