ATC110623: Report Study Tours to Netherlands

NCOP Health and Social Services




19-25 FEBRUARY 2011



 MARCH 2011                 

Compiled by Dr T. Ganyaza-Twalo

Contributors: Ms M. Williams &

Mr M. Dlanga







  1. Mrs N. R. Rasmeni – ANC & Chairperson
  2. Ms Z. D. Rantho – ANC
  3. Mrs L. M. Moshodi – ANC
  4. Ms M. G. Boroto – ANC
  5. Ms B. V. Mncube – ANC
  6. Mr T. A. Mashamaite – ANC
  7. Mr M. J. R. de Villiers – DA
  8. Mr W. F. Faber – DA
  9. Mr S. H. Plaatjie – COPE




  1. Dr Thulisile Ganyaza-Twalo – Content Advisor
  2. Ms Marcelle Williams – Committee Secretary
  3. Mr Mzuyanda Dlanga – Committee Secretary







1.1         Introduction                                                                                                          1

1.2         Aims and Objectives of the Study Tour                                                                    2

1.3         Methods of Information Collection                                                               2




2.1   Background to Netherlands Health Care System                                                         4

2.2   Situation before the Reforms                                                                                     4

2.3   Reasons for Reform                                                                                      5

2.4   Introduction of the Health Insurance Act, 2006                                                            5

2.5   Packaging of the Dutch Health Care System                                                  7

2.6   Health Care Financing                                                                                              8

2.7   Quality Assurance and Monitoring of the Health Care System                          8

2.8   Lessons from the Dutch Health Care System                                                             10

2.9   Recommendations for the Parliament (Committee)                                          10




3.1 Background Information                                                                                             11

3.2 The Hague Convention on Protection of Children and Co-operation in Respect of Inter-Country Adoption: An International Framework for Child Protection                12

3.2.1 Background                                                                                               12

3.2.2 The principal features of the Convention                                           12

3.3   Adoption in Netherlands: The Legal Framework                                                           13

3.4   Procedure for Adoption                                                                                             14

3.5   Learning about Inter-Country Adoptions                                                                      15

3.6   Recommendations for the Committee                                                                        15




4.1 Introduction                                                                                                              16

4.2 Medical Knowledge Institute (MKI) – “Prevention through Education”                 16

4.3 Holland Stellenbosch Medical Foundation                                                       16

5. CONCLUSION                                                                                                           17





1.1   Introduction


The NCOP’s Select Committee on Social Services undertook a study tour to the Netherlands from the 19 – 25 February 2011. The committee decided on this study tour pre-empting the introduction of National Health Insurance to Parliament, a system which will reshape South Africa’s health care system. Also, it decided on Netherlands as a country which was perceived to have one of the best health care systems in the world, and thus provided opportunities for learning from its health care system. The learning therefore from the Netherlands health care system will help Members of Parliament (MPs) in their deliberations on the proposed National Health Insurance.


In addition to learning about Netherlands’ health care system, the committee wanted to explore ways to protect South African children adopted by foreign citizens. It thus looked at inter-country adoptions as a mechanism for promoting and ensuring such protection of adopted South African children by foreign citizens.


Various government departments, independent and non-governmental organisations were visited to gather the relevant information in order to understand both Netherland’s health care system and laws, policies and procedures that guide inter-country adoptions. (See annexure 1 for the list of the departments and organisations visited)


This report therefore reflects learning from the Dutch health care system and how the country regulates and conducts inter-country adoptions. In reporting on the Dutch health care system, it touches on the collaborative work between the Dutch and South African organizations; and the work done by the Dutch in South Africa in the field of health.


As part of overall oversight and monitoring of committee activities, this report is a means of 1) accounting to Parliament on the committee’s activities whilst in Netherlands; and 2) verifying the committee’s performance against its strategic and annual plans for the period 2009 – 2014 and 2010 performance in particular.


The report is structured and/or divided into four parts. The first part of the report includes this section which is the introduction to the report; objectives of the study tour; and methods of information collection. The second part provides information on Netherlands’ health care system. The third part focuses on inter-country adoptions. The fourth part provides information on collaboration between South Africa and Netherlandsinstitutions.


1.2      Aims and Objectives of the Study Tour


The aims of the study tour were to:


  1. Explore and learn from Netherlands’ health care system; and
  2. Ensure the protection of South African children through learning about inter-country adoptions.


The objectives of the study tour were to:


  1. Explore and understand Netherlands’ health care system;
  2. Understand health care financing;
  3. Explore matters around human resource for health care provision; and
  4. Explore ways and means to protect South African children adopted by the foreign nationals.


1.3               Methods of Information Collection


In order to achieve the aims and objectives of the study tour, the South African delegation held meetings with various role-players in Netherlands. The delegation met the South African Ambassador to Netherlands, Peter Goosen, who welcomed the South African delegation to that country. The Ambassador later in the programme gave a presentation on the Development Cooperation Project Database the embassy developed as a way of tracking partnerships between South African and Netherlands’ organisations in a variety of focus areas and businesses. The database also provides information as a reference for establishing partnerships between these two countries. The database is a very useful tool to obtain information in any field for networking and business purposes. 


The delegation first visited Parliament and met with three Members of Parliament (MPs) from different political parties. These were Federal Party, Socialist Democratic Party and the Labour Party. These MPs also serve on their Parliament’s Committee on Health Care. Unfortunately at the time of the visit, Parliament was in recess and the delegation did not get an opportunity to witness the committee in session.


The delegation visited and met with representatives from various organizations and/or role-players in the Netherlands’ health care system. The organisations ranged from government, academic institutions to non-profit organisations working in the health sector. The following institutions were visited to gather information on their health care system:


  • Ministry of Health, Welfare and Sports;
  • Ministry of Foreign Affairs;
  • Netherlands’ Institute for Health Promotion; and
  • Royal Dutch Medical Association (KNMG).



Institutions working in or in collaboration with South African organizations included:


  • Holland Stellenbosch Medical Foundation;
  • Medical Knowledge Institute (MKI);
  • Oxfam Novib; and
  • Philips Healthcare.


Regarding inter-country adoptions, the delegation visited the following organisations:


  • Hague Conference on International Law (HccH);
  • Council for Protection of Children; and
  • Foster Care Centre.


The mode of information sharing was largely through power-point presentations followed by discussions where the MPs would be given opportunity to ask questions to explore and probe on issues raised in the presentations. In some instances, books were made available to learn more about topics of interest to the delegation. Information presented in this report therefore comes from the presentations and the books provided to the delegation on these two crucial topics.





2.1   Background to Netherlands Health Care System


The Netherlands’ health care system is a fairly new system which still faces some transition related challenges. As recent as 2006, health care reforms took place which saw the introduction of a single compulsory insurance system in which multiple private health insurers would compete for insured persons.


The new system seeks to introduce dynamism in health care. The concept of dynamism is premised on three strategic issues which are 1) health care and sport nearby; 2) value and quality for your money; and 3) opportunities for people and entrepreneurs. These three key strategic agenda issues define Netherlands’ health care system. 


The introduction of new reforms in health care ushered in radical changes in the roles of various actors in the system. These changes included 1) the role of health insurers and patients; 2) supervision and management of the system was largely moved from government to independent bodies; and 3) the provision of social support became the responsibility of local government.


The introduction of the new system also saw changes in the structure of the health care system. It is best described as having three pillars which are the providers, citizens/consumers and the insurers. Each of these role players where expected to play a certain and crucial role to ensure the success of the system.


2.2   Situation before the Reforms


In 1967, a social insurance scheme replaced subsidies to inpatient long-term care, mental health and disability services.[1] Eligibility was broadened with long-term care, elderly care and mental health services. In the 1970s, policy trends were around cost containment; measures to solve the fragmented service provision; and the attempts to abolish the dual system of social and private health insurance.


The health care system was characterised by greater involvement of government in the regulation of health care. Thus, the capacity of the system to deliver was heavily regulated by government. In regulating the health care system, government set tariffs for services provided by the medical practitioners and health insurers.


The previous health care system had three levels which consisted of 1) sickness funds (2/3 = two thirds), private insurance (1/3 = one third), and 3) partial insurance for civil servants. This system largely remained until the introduction of new health care reforms in 2006.


2.3    Reasons for Reform


After many attempts to reform the health care provision in Netherlands dating back to the 1960s, a new policy paper titled “A question of demand”.[2]  This paper formed the basis for systemic health care reforms. The systemic health care reform debates broadly included questions around managed competition and the desired single compulsory health insurance scheme for all Dutch residents.


The reason for health care reforms included the following factors:


·         Lack of cost consciousness by the consumer,

·         Unexpected financial effects around the income threshold,

·         Fragmented insurance market,

·         Different rules of market game,

·         Lack of transparency,

·         Lack of efficiency,

·         Lack of innovation, and

·         Long waiting lists of citizens awaiting health care services.


During the time of economic boom, the growing wealth, advancing medical technology and aging population placed increasing pressure on the system. A solution to the above-mentioned pressure, the solution was advocacy for less central regulation and introduction of more competition in the health care system.


2.4   Introduction of the Health Insurance Act, 2006


The introduction of this Act saw the beginning of major changes in the structuring of the Dutch health care system. It abolished and/or collapsed the sickness fund, private insurance and the partial insurance for civil servants. The fragmented health care insurance was integrated into one system which enabled access to health care by all citizens and managed competition among actors in health care.  


The 2006 health care reforms introduced a single compulsory insurance scheme, in which multiple private health insurers compete for the insured persons.[3] The introduction of the health reforms radically changed the roles of different actors, in particular the role of health insurers and patients. The supervision and management of the system have been largely delegated from the government to independent bodies. Importantly, the organization of social support became a municipal responsibility. 


The public characteristics of the Health Insurance Act were:


·         Insurer is obliged to accept every resident,

·         Insurer is responsible for availability of insured cure,

·         Insurance is compulsory for every resident,

·         Introduced national standard/basic package of health care,

·         Income related premium (50%),

·         Risk equalisation,

·         Financial compensation for poor people for a nominal premium, and

·         No premium for children.


Three major role-players emerged as a result of the reforms in the health care system, viz government, insurers, service providers and the insured. All these actors play crucial roles in making the system a success. Government is responsible for regulation and supervision of the system. This is largely done through engagement with academic and independent institutions which conduct research in the field of health care. Government also has an overarching responsibility over the other actors in the health system, which includes insurers, the insured and providers of service. 


Figure 1 below shows the other major actors and markets in the Dutch health care system. Insurers collect and/or receive contributions from the insured and pay for services provided by the providers. Service providers provide health care services to the insured and claim for their services from the insurer. The insured receives medical care paid for in advance to the insurer.




(Regulation and supervision)



























Figure 1: Actors and markets in the Dutch health care system since 2006. Taken from the “The Netherlands Health Care Review”

The benefits of the new health care system were the vanishing of the waiting list for the care of medical specialists. Insurers invested much more on the quality of care for the citizens. There was also more room for innovation in health care.


The burdens/disadvantages of the system include intensified negotiations becomes a burden when insurers try to improperly influence the physicians’ behaviour to save on medical spending. A risk exists for general practitioners in their function of gate-keeper to hospital care.


2.5   Packaging of the Dutch Health Care System


Basically, the Dutch health care system is characterised by two forms of delivering health care services. These include basic and additional packages for delivery health care services to its citizens. Basic package consist of essential medical services and the second package is additional to the basic package meaning that a person can choose to subscribe or not to the additional package.


2.5.1 Basic Package: This package is determined by government and is standardized throughout the system. This means that government is responsible for the packaging of the basic package.


The basic package consists of all essential medical care as determined by government. The insurance thereof is compulsory for every citizen of the country. There is no competition on price and quality of care between the health insurer and health care provider.


2.5.2 Additional Package: With this package, the responsibility for packaging of health care services is left entirely to the insurers. The package consists of all sorts of care services not provided for in the basic package. Therefore, there is variation per insurer and between insurers with regards to costing of services.


The other difference from the basic package is that insurance is voluntary thus giving the person a choice whether to insure or not. This additional package also introduced competition on packages and prices between insurers. With this competition between insurers, the persons become beneficiaries because it tends to lower costs for these health care services.  


2.6    Health Care Financing


Health care services are financed in two ways. Firstly, government deducts fifty percent (50%) of medical consumptions from the employees. The amount of contribution is dependent on the income of the employee. The collected funds are then deposited into the Risk Adjustment Fund (RAF). Some of these funds are then disbursed to the health insurers to subsidise the medical costs incurred by the consumers/patients.


The consumer/patient pays the remaining 50% of medical costs to the health insurer. The amount paid to health insurers in real terms varies as a direct result of competition between health insurers for the insured by the various health insurers. On average, employees spend about 3.5% of their salaries on health care insurance.

In financing health care service provision, children under the age of eighteen (18) years enjoy free medical care. This means that funds from the Risk Adjustment Fund also serve to subsidise services provided to children under the age of 18years.


2.7   Quality Assurance and Monitoring of the Health Care System


Providing quality health care is central for the Dutch government. The Dutch view the delivery of high quality care as a professional responsibility. Health care service providers are thus required to report about the quality of service.


Four Acts passed by Parliament serve to guide quality assurance in health care service provision. These Acts are:


·         Health Care Market Regulation Act,

·         Quality Act,

·         Health Care Provider Accreditation Act, and

·         The Patients Rights Act.


Supervisory bodies ensure adherence to the quality standards set out in the Acts and subsequent policies. These are:


  • The Health Care Inspectorate, and
  • The Dutch Healthcare Authority.


The active monitoring of quality in health care involves health insurers, consumers/patients and health care providers. Government in this process safeguards quality, access and affordability of health care services.


An independent coherent analysis of the performance of healthcare at system level is reported on in the Dutch Health Care Performance Report. The report focuses on the achievement of three system goals set out by government, which are quality, access and affordability (costs). The report also focuses on the impact of the health care reforms by using time trend data or international comparisons whenever possible.


The Royal Dutch Medical Association (RDMA) sees to the processes and procedures to be followed to ensure that service providers are accredited and fit to provide health care services. Service providers in this context include the hospitals and medical practitioners. The Association developed frameworks for various players in health care provision.


Quality Framework of Hospital Management: The association ensures that the following are done at hospital level:


  • Hospitals are accredited to provide health care services,
  • Registration of accidents and near accidents,
  • Registration of quality indicators (such as waiting time, necessity of re-operation, etc),
  • Standard regulation for complaining patients, and
  • Performance evaluation (management evaluates performance of salaried medical specialists).


Quality Framework for Medical Specialists: medical specialists must adhere to the following:


·         Registration as medical specialists

All specialists must receive their education at university and also receive on the job training.


·         Re-registration every 5years

The RDMA prescribes minimum hours of practice (16 hours patient care per week); continuing medical education (200 hours); and quality visitation (e.g. specialists of hospital A visit specialists of hospital B).


Quality Framework of the RDMA: obligations for the individual medical specialist to:


·         Minimum number hours of practice,

·         Use medical guidelines,

·         Use quality indicators,

·         Continuing medical education (200 hours),

·         Quality visitation, and

·         Performance evaluation by peers.


In summary, this is how the Dutch health care system ensures provision of high quality health care services.


2.8   Lessons from the Dutch Health Care System


  • Reforms to achieve real or specific objectives as analyzed by the government. Dealing with the aging population and addressing access to health care by everyone.
  • Recognition of the importance of roles played by various actors in the health care system. That is the government, health insurers, providers, insured/consumers and independent institutions.
  • Packaging of health care services to benefit all, including those unemployed and cannot afford paying for services on their own.
  • Promotion of high quality health care service provision monitored by various role players. 
  • Financing health care lies with all actors in the system.


2.9   Recommendations


The stated recommendations relate to the above-mentioned lessons from the Dutch health care system. They take into consideration the mandate and functions of the parliamentary committees.


  1. In assessing and interrogating the soon to be introduced National Health Insurance Bill, the Committee should probe and ascertain whether 1) the Bill is addressing an identified problem(s); 2) there is a clear basis for the proposed reforms in health care; 3) the proposed health care system and its programmes will actually achieve the intended objectives and outcomes.
  2. Parliament, through its relevant committees, should monitoring the implementation of the National Health Insurance as it is critical to find gaps and areas for further improvements. This could be done by independent institutions through research. The committee or Parliament must therefore exercise oversight by ascertaining from the Department of Health whether there are plans to conducts impact studies.
  3. The success of the National Health Insurance will depend partly on the involvement and role of various stakeholders inside and outside of government. It is thus imperative for the committee to ascertain the extent to which other critical partners are involved. Also, whether their roles are clearly defined to assist with implementation and evaluation of NHI.
  4. Cost estimates to government should guide the means by which implementation occurs.






3.1 Background Information


In trying to learn about practices on inter-country adoptions with a view to child protection, the delegation visited the Hague Conference on Private International Law (HccH); Ministry of Security and Justice: Child Protection Board and the Council for Protection of Children. Information presented in this section comes from presentation by the above-mentioned institutions.


The opening up of national borders, ease of travel, worker mobility and the breaking down of cultural barriers have, along with their many benefits, brought new risks for children. The cross border trafficking and exploitation of children and their international displacement as a result of wars, civil disturbance or natural disaster have become major world problems.


Children also find themselves caught up in the turmoil of broken relationships within transnational families, which can lead to disputes over custody and relocation, the hazards of international  parental abduction, problems of maintaining contact between the child and parents living in different countries, the struggle of securing cross-frontier child support, and the pressures and profiteering which can sometimes accompany the cross-border placement of children through inter-country adoption or shorter term arrangements.


As the United Nations (UN) Convention on the Rights of the Child (1989) underlines, effective protection of children’s rights across frontiers cannot be achieved without inter-State co-operation. The three modern Hague Children’s Conventions have been developed over the last twenty five years, and to provide the practical machinery to enable States to work together where they have a shared responsibility to protect children.


About the:


Hague Convention of Private International Law


The Hague Conference on Private International Law has been a pioneer in developing systems of international co-operation, at the administrative and judicial levels, to protect children in cross-frontier situations. This work has been taking place for more than a century. HccH is an international inter-governmental organisation with nearly 70 Member States from all continents. It provides legal security and protection for persons and businesses whose movements and activities cross national frontiers. 


HccH’s mandate is to harmonise private international law rules at the global level through the preparation, negotiation and adoption of Hague Conventions (multilateral treaties to which more than 120 States around the world are currently Parties).


HccH has a footprint in Africa. In 2010, it provided technical assistance regarding adoption issues in four African States – Kenya, Namibia, Madagascar and South Africa. To this effect, four (4) seminars were held in 2010. The South African seminar focused on Cross-Frontier Child Protection in the Southern and Eastern African Region. This seminar was held in Pretoria in February 2010.


3.2 The Hague Convention on Protection of Children and Co-operation in Respect of Inter-Country Adoption: An International Framework for Child Protection


3.2.1 Background


The Convention on Protection of Children and Co-operation in Respect of Inter-Country Adoption is an international framework to facilitate inter-country adoptions. The Convention recognises the importance of a child growing up in a family environment with love and happiness. Inter-country adoption is one of the means to ensure that a child grows up in a family. However, it cautions that inter-country adoption should be considered after attempts to find a family in a country of origin has yielded negative results. The best interest of the child and recognition of the child’s rights are paramount when considering and facilitating inter-country adoption.


The objectives of the Convention are to:


  • Establish safeguards to ensure that inter-country adoptions take place in the best interest of the child and with respect for his or her fundamental rights are recognised in international law.
  • Establish a system of co-operation amongst Contracting States to ensure that those safeguards are respected and thereby prevent abduction, the sale of, or traffic in children.
  • Secure the recognition in Contracting States of adoptions made in accordance with the Convention.


3.2.2 The principal features of the Convention 


  • The best interest of the child are paramount


Article 4(b) of the Convention requires States to determine, after possibilities for placement of the child within the State of origin have been given due consideration, that an inter-country adoption is in the child’s best interests. In determining the “child’s best interests”, the State must national solutions are considered first; ensure the child is adoptable; preserve information about the child and his/her parents; evaluate thoroughly the prospective adoptive parents; match a child with a suitable family; and impose additional safeguards where needed. This fundamental principle should thus guide the development of an integrated national child care and protection system, of which one part is an ethical, and child centred approach to inter-country adoption.


  • Subsidiary Principle


This principle, “Subsidiary” means that Contracting States recognise that a child should be raised by his or her birth family or extended family whenever possible. This implies that only after due consideration of national solutions first that inter-country adoption should be considered and facilitated. This principle emphasises the importance of keeping a child in the care of his/her family or a family in the country of origin.


  • Safeguards to protect children from abduction, sale and trafficking


This is one of the key objectives of the Convention. At the core of this safeguard is protection of birth families from exploitation and undue pressure; and ensuring that only children in need of a family are adoptable and adopted. Also, it prevents regulating agencies and individuals involved in adoptions by accrediting them in accordance with Convention standards.


  • Co-operation between States and within States


Co-operation between States is crucial to ensure the effectiveness of the safeguards put in place in Article 1(b) of the Convention. This in recognition of the fact that all those involved in adoptions, whether intra- or inter-country should work together to effect the safeguards of this Convention. 


  • Automatic recognition of adoption decisions


Every adoption which is certified to be made in accordance with the Convention procedures, is recognised “by operation of law” in all other Contracting States (Article 23). In effect, the Convention gives immediate certainty to the status of the child, and eliminates the need for a procedure for recognition of orders, or re-adoption, in the receiving country.


  • Competent authorities, Central Authorities and Accredited Bodies


The Convention requires that only competent authorities should perform Convention functions. These may be Central Authorities (Article 6 & 7) and accredited bodies. Articles 6-13 of the Convention outline a system of Central Authorities in all Contracting States and impose certain general obligations on them. The system and general obligations include among others the co-operation with one another through exchange of information concerning inter-country adoption; elimination of any obstacles to the application of the Convention; and a responsibility to deter all practices contrary to the objects of the Convention.


It is critical for Contracting States like South Africa to embrace the obligations put on it by this Convention even on its internal laws and practices.


            Adoption in Netherlands: The Legal Framework


Domestic and inter-country adoptions are allowed in Netherlands. However, there are laws and regulations that guide the adoption of children and adoption consequences thereof. These include:


  • Book 1 of the Civic Code, containing provisions on the law of family and persons, particularly articles 227 – 232 on adoption.
  • Act of 8 December 1998, containing provisions on the reception in The Netherlands of foreign foster children for adoption (hereafter referred to as the Act on the adoption of foreign children, since this Act is the principal legal instrument governing adoption of foreign children).
  • Act of 14 May 1998, ratifying the Hague Convention.
  • Act of 14 May 1998, implementing the Hague Convention.
  • Act of 3 July 2003, on the applicable law in adoption matters.
  • Act of 21 December 1951, containing provisions on the care and education of foster children.
  • Act of 8 August 1989, containing provisions on the care of the youth.
  • Act of 19 December 1984, on Dutch nationality.


An order for adoption has to be made within confines of these laws as they apply to various legal matters including citizenship. Furthermore, the provisions of the Hague Convention are incorporated into the legal system as far as inter-country adoption is concerned. Learn more about the Hague Convention in 3.2 above.


            Procedure for Adoption


This section outlines the adoption procedure in brief. This is done in steps that the officials adhere to.






Submitting a request for a permit in principle

Applies for a permit in principle by sending an application to Foundation Adoption Services.


Review of the application

Check if requirements for entering the adoption procedure are met. These requirements concern the sort of application and the age of applicants.


Information sessions

Attendance by an applicant of information sessions. Focus is on sharing information about the child.


Home study

Child Protection Board conducts home study and thereafter advises the Minister of Security and Justice as to the issuing of a permit in principle. The report of the Board is also used in the country of origin to determine which family is most suited for placement of the child eligible for adoption.


Permit in principle

The Minister of Security and Justice decides on the basis of the home study report whether to issue a permit in principle.



Done by a license holder mediating for children.


Proposal of a child for adoption

Through the license holder, a child may be proposed for adoption. Prospective parents cannot choose a child.


Arrival of the child in the family

Check if all requirements are met and if all documents are in order. This is because few countries escort adoptive children into Netherlands.


Registering the child with the Authorities

Formalities relating to the arrival and status of the child.

            Learning about Inter-Country Adoptions


  1. Formal legal framework for inter-country adoption which is understood by all involved with inter-country adoption.
  2. Contracting and embracing the provisions of the Hague Convention thus putting them into practice when inter-country adoptions are facilitated.
  3. Various actors have specified roles in the processing of inter-country adoptions.


            Recommendations for the committee


  1. Through an exercise of oversight, the Committee must establish whether the country’s inter-country adoption processing complies with the provisions of the Hague Convention.
  2. The committee to establish whether there are independent bodies facilitating the adoption of South African children adopted by foreign nationals. Also ascertain the types of screening processes that are currently applied for adoptive parents.
  3. Members of Parliament and provincial legislatures should start a dialogue that will result in a unified strategy to advocate for South Africans adopting South African children. Recruitment drives should include radio air time in broadcasting the message of SA parents adopting SA children.





4.1 Introduction


Collaborative work between South African and Netherlands institutions has been happening for many years now. The focus of this section is on the Dutch non-governmental institutions doing work in collaboration with South African institutions.


4.2 Medical Knowledge Institute (MKI) – “Prevention through Education”


MKI is an international non-profit health organization, established in the Netherlands. It aims at education and information provision, preceding from the belief that healthcare is a human right. Its objective is to improve the living conditions of the population by giving health related trainings and workshops to local aid workers.


MKI Initiatives:


The Mother and Child First Training Program: this program is intended for midwives and other healthcare employees for the prevention of the transmission of HIV from mother to child in developing countries. Health Information Centres have been set up in various townships for this purpose.


Clover Mama Africa: this is a conglomerate of 33 orphanages which are provided with Health Information Satellites thus reaching a claimed 25 000 children through courses and training in the fields of hygiene.


Biometric Health Passport: this project aims to issue personalised passports that have data about an individual’s health records. However, it is still at pilot stage but should be valuable for individuals and communities.


Happy Days Project: aims to break the taboo that still surrounds menstruation which results in girls and young women not receiving explanation about the development of their bodies. It thus provides information about personal hygiene and trains female trainers to pass on this information to disadvantaged young women. 


Yoell: which focuses on production of exclusive jewellery, handmade by HIV infected women in South Africa. With the money that the women earn, they become economically independent and able to provide for their own families. Jewellery from this project can be viewed at   


4.3 Holland Stellenbosch Medical Foundation


The Holland Stellenbosch Medical Foundation (HSMF) was established in 2001 by 3 Dutch pulmonologists who worked at Tygerberg Hospital from 1982 – 1984. The Foundation has partnered with Ukwanda, Centre for Rural Health and University of Stellenbosch’s Faculty of Health Sciences. Some of sterling work includes the building of “The Holland House” – Baphumelele Orphanage in Khayelitsha, Cape Town in 2010.


Aims and Objectives:


The Foundation raises funds in order to contribute in all modesty to sustain, develop and improve the level of healthcare in South Africa through:


  • Educational projects,
  • Bursaries for previously disadvantaged medical students,
  • Rural health projects,
  • Training programs for medical staff in general, and
  • Funding towards the purchase of essential equipment.


The Foundation supports medical educative projects. It conducts this work through:


  • Providing bursaries for underprivileged students;
  • Providing medical and ICT equipment for learning purposes (Tygerberg Hospital);
  • Special projects: HIV-TB project, TB course RUDASA; and
  • Avian Park Service Learning Centre.





The report introduced the purpose, aims and objectives, and how the information presented in it was collected. It thus provided an overview of the Netherlands health care system. In doing so, it provided some lessons from their health care system. Then, it presented some recommendations for the committee to consider when deliberating on matters related to the proposed National Health Insurance.


The report also provided information on inter-country adoptions. It thus presented lessons and recommendations with regards to the protection of South African children when adopted by international citizens.


Information on collaboration between South Africa and Netherlands non-governmental organization is also presented. The section show-cased the type of projects and work done in health related matters. 




1.       The Netherlands Health System Review, 2010

2.       Mr Goosen, South Africa Ambassador to the Kingdom of the Netherlands.

3.       Holland Stellenbosch Medical Foundation

4.       Medical Knowledge Institute (MKI)

5.       Oxfam Novib

6.       Philips Healthcare

7.       Hague Conference on International Law (HccH)

8.       Council for Protection of Children

9.       Foster Care Centre.


[1] The Netherlands Health System Review, 2010

[2] The Netherlands Health System Review, 2010

[3] The Nethelands Health System Review, 2010


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