When gaps in law- and regulation are combined with decentralization, many barriers arise. This makes it quite difficult to scale up care for specific target groups. Question remains: how do you get it moving?


In the Netherlands we know the Public Health Act (wpg). Public health is herein defined as 'protective and promoting measures for public health', or specific target groups within it, including the occurrence and early detection of diseases is also included.” One of the areas covered by the Wpg is the implementation of youth health care, the JGZ.

Most children and young people in the Netherlands grow up healthy and develop well. This is partly due to the efforts of JGZ, an organization that now has more than 100 year exists. From the Basic JGZ package, the organization 'sees' children and young people together with their parents until they are eighteen. However, JGZ is not active in MBO due to a 'historical flaw', as a result of which a large group of 16-year-old pre-vocational secondary education students lose their image of JGZ after their graduation. This is a pity, because absenteeism, early school leaving and mental problems are relatively more common among young people between 16 and 23 year, the adolescents. Higher vocational education students in particular often suffer from this. As a youth doctor in Amsterdam I would like to say: let's adolescents across the country, regardless of their school type, offer care until their 23rd. In Amsterdam we do this from 2009 already successful at secondary vocational education, due to good agreements between the alderman, MBO institutions and the JGZ. Financing at municipal level has also been realised.


The belief that an 18-year-old is already an adult, remains an old and ingrained thinking pattern. We now know that young people between the 18 and 23 years still undergo a very essential development and often cannot be considered as fully mature yet. Breaking this thinking pattern is necessary, because only then will the right and appropriate support come to the right place. To offer the MBO adolescent the help she needs, is the method M@ZL (Medical Advice for Pupils Reported Sick) an effective and helpful tool. The youth doctor work at M@ZL, the student and/or parent, the care coordinator/mentor of the school and compulsory education together in the event of absenteeism. The parties involved work and act together on the basis of their common concern. Everyone operates from his own role and always together with the young person. From the ideology that absenteeism is often a signal, can psychosocial and (social)medical problems are identified and addressed at an early stage.

After a successful start in West Brabant, the M@ZL method was put into use in Amsterdam – both in secondary education and in vocational education. There are now eleven youth doctors working in secondary vocational education in Amsterdam, who use the preventive and effectively proven approach M@ZL. From the positive experiences in West Brabant and Amsterdam, among others, is it a logical step to implement this method nationally. In that case, however, there must be structural funding for youth doctors in secondary vocational education.


It appears to be quite problematic due to legislation and funding to implement youth doctors for adolescents and M@ZL in secondary vocational education. Firstly, financing is difficult to achieve. The JGZ offer that is offered to all children in the Netherlands, is legally established in the Public Health Decree: the JGZ Basic Package. The age limit of this package is per 1 January 2015 to be fond of 18 year. There are therefore many adolescents at MBO who miss the boat in this regard, as they exceed the age limit of 18 have already passed. With a youth law (2015) until 23 year this is remarkable.

In addition, many MBO schools have, different than in Amsterdam, students from different municipalities. A JGZ sometimes serves different municipalities. However, care is organized differently in every municipality and there must be agreement with the aldermen from these various municipalities (collaboration between JGZ organizations, the GGD and schools, for instance). In this complex situation it is difficult to find sufficient support and financial resources for a program such as M@ZL. Realizing a good collaboration between students, mentor, pediatrician, Unfortunately, this means that parent and compulsory education officer does not get off the ground sufficiently. In addition, in practice, teachers and mentors often do not have the time or capacity to identify problems in students. many see it, despite the appropriate education law, not even their job. The focus is on teaching.


  1. Scaling up remains extremely difficult in healthcare. In this case mainly due to the decentralized differences in the healthcare systems and the associated gaps in legislation- and regulations. These factors make it difficult to find support for and funding for youth doctors for adolescents in vocational schools.
  2. The NJC (Dutch Center JGZ) in INGRADO (association departments of compulsory education of the municipalities) are committed to it and there is also a dialogue with the VWS, but there is still too little national implementation of the youth doctor for adolescents and the scaling up of M@ZL.
  3. We see an increase in psychosocial problems among adolescents. We have knowledge and expertise about prevention in this area, but it remains difficult to make a structural policy at local municipal level. The decentralization (youth law) does not provide a solution and as a result, the commitment of youth doctors in MBO lags behind the urgency and need in practice.
  4. The M@ZL methodology is being implemented here and there, but this often happens in a modified form, including from a financial point of view. As a result, reliability and effectiveness are no longer guaranteed.

Name: Wico Mulder
Organization: JGZ/GGD Amsterdam


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