All Dutch citizens are invited, at a certain point in their lives, to participate in one of the national screening programmes. The State initiates, sets up and finances three cancer and five prenatal and neonatal population screening programmes. The RIVMNational Institute for Public Health and the Environment Centre for Population Screening (RIVM-CvB) directs and manages the National Population Screening Programme on behalf of the Ministry of Health, Welfare and Sport.

National Population Screening Programme

A population screening programme is a systematic offer of medical examinations for a specific disease to a population of apparently healthy, asymptomatic individuals. The National Population Screening Programme consists of eight screening programmes.
The screening programmes are intended to identify diseases at an early stage so that prompt treatment can be given. In the case of prenatal screenings, parents are informed about the health of their expected child and on the options available.

The breast cancer screening programme is designed for women aged between 50 and 75. The target group is invited every two years for a mammogram.

The cervical cancer screening programme focuses on women between 30 and 60 years old. Once every five years, this target group is invited for a smear test. In addition, women can request a self-sampling device. Both tests are tested for HPV, with cytology triage.

The screening programme for colorectal cancer is for men and women in the age group 55 to 75 years. The screening is done by testing stool samples by the participants themselves, using a home kit (FIT).

Screening programmes for pregnant women and newborns

This screening is meant for women, preferably before their 13th week of pregnancy . A blood sample is taken and tested for blood groups ABO, Rhesus D, Rhesus c, irregular erythrocyte antibodies and infectious diseases, such as HIV, Hepatitis B and Syphilis.

Pregnant women have the option to test their child before birth. Women in their 9-14th week of pregnancy can opt for tests that screen for Down’s, Edwards’ and Patau’s syndromes. This can be done via a combined test (blood test and ultrasound) or the NIPT (blood test).

Parents who are expecting a child can have their unborn baby tested for spina bifida or other genetic disorders. The ultrasound is performed between the 18th and 22nd weeks of pregnancy.

Babies are tested for hearing loss within four to seven days after birth. This test is in most of the Netherlands offered together with the heel prick test.

In the first week after birth, children are tested for more than twenty severe treatable congenital disorders. This is done by using a special device and collecting four drops of blood from the child’s heel.

Public values

The Ministry of Health, Welfare and Sport (VWS) charged the RIVMNational Institute for Public Health and the Environment with the coordination of the National Population Screening Programme. The implementation of these programmes must meet the public values as described by the government: quality, accessibility and affordability. The objective is to achieve health benefits and offer citizens treatment options through a familiar, accessible, safe and integrated range of high-quality population screening at reasonable costs.

 

The Population Screening Act

The Netherlands is one of the few countries worldwide where the preconditions for screening are legally established in the Population Screening Act (WBO). This Act was introduced in 1992 and provides protection against unnecessary or harmful screening programmes. It outlines all the requirements that have to be met to ensure the quality of the screening.

A WBO permit is required for the following screenings in order to execute a screening programme:

  • Screenings making use of ionising radiation (x-ray)
  • Screenings for cancer
  • Screenings for severe non-preventable diseases with no possible treatment

The WBO therefore monitors all screenings and not only those of the National Population Screening Programme. If the permit is issued, it means that the screening is scientifically sound, that it is in accordance with legal rules for medical treatment and that the expected efficacy of the population screening outweighs the risks to health.

 

Implementation of a new screening programme

What steps are taken before a screening programme can be introduced nationwide? The screening programme for colorectal cancer is the most recent addition to the National Population Screening Programme. The phased roll out started in 2014 but the entire realisation process took 13 years.  An overview of the implementation process and the involved parties can be found in the factsheet: Lessons learned from the introduction of the colorectal cancer screening programme in the Netherlands.

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VOICE-OVER: The Centre for Population Screening directs and coordinates
the seven national population screening programmes
that are offered by the Dutch Government.
In this presentation, we explain the core activities and responsibilities
of the Centre for Population Screening.
There are seven population screening programmes
offered by the Ministry of Health, Welfare and Sport.
Each of the seven screening programmes is offered to a unique group of people.
They include pregnant women, newborns and adults in different age groups,
without symptoms of the disease under investigation.
A large number of organisations carry out the population screening programmes.
Each party has its own responsibilities and authority.
Thanks to the joint efforts of these organisations and their professionals,
the population screening programmes contribute to a healthier society.
The Minister of Health, Welfare and Sport is ultimately responsible
for the national population screening programme.
The minister is at the head of the organisation of screening programmes.
She makes final decisions, determines the preconditions,
distributes assignments and finances the programmes.
The Ministry of Health, Welfare and Sport
has given the Centre for Population Screening the assignment and the assets
to coordinate the seven population screening programmes.
The centre is also responsible for the national influenza prevention programme.
The task of the Centre for Population Screening is to achieve health benefits
through a range of high-quality population screening programmes.
The screening programmes should be accessible, safe and integrated
within the healthcare system at reasonable costs.
Effectiveness, quality and affordability are therefore among the predominant criteria
within the screening programmes.
The Ministry of Health, Welfare and Sport
has given the Centre for Population Screening the assignment
and provided the finances to coordinate the seven population screening programmes.
The Centre for Population Screening further distributes assignments
and finances to the private and the public sectors.
The tasks and responsibilities to implement screening are devolved to executing parties
that, in the centre's experience, are most competent.
This is often done by setting up contracts or agreements with executing parties.
The centre oversees all collaboration and makes sure that it works out successfully.
We will now give a more detailed example of the key responsibilities
of the Centre for Population Screening.
The centre either finances population screening itself
or directs other organisations to do this.
Financing is mainly achieved through procurement or subsidies.
With procurement, detailed demands and preferences are drafted,
in regards to the provision of a service or product.
For example, a laboratory analysis or a mammography machine.
The demands and preferences are then published in the market,
so private companies can compete for the contract to deliver the service or product.
The company that can deliver the service or product at the best price-quality ratio
is granted a contract.
With subsidies, an organisation in the screening process,
such as a midwife organisation or a GP organisation,
is approached to do additional work for the screening programme.
The quality requirements and the amount of time that needs to be spent on each activity
will be agreed on, and then the costs for the additional work estimated.
The Centre for Population Screening is responsible
for executing or overseeing the procurement and subsidy processes.
The centre is in charge of assessing quality and assuring the quality
of all seven screening programmes.
In many cases, a reference function, an independent assessor, is set up
for assessing the quality of screening professionals and screening equipment.
Licences and permits are granted by the assessor,
and regular inspections take place.
The assessor optimises and safeguards medical, technical and physical quality.
The Centre for Population Screening is responsible
for the quality of entire programmes and designs quality assurance systems.
It drafts guidelines, scripts, training and accreditation requirements.
The centre is responsible for ensuring good information management
within the screening process and the executing organisations.
Digital information is crucial in managing the primary process
of planning, selecting, inviting and screening the population.
The Centre for Population Screening directs huge IT systems and operations
on linking the information needed from all kinds of different data sources.
With the right information in the right place, key processes can be monitored.
The centre is also responsible
for monitoring the quality of screening programmes
and evaluating aspects for improvement.
Each year, the Centre for Population Screening publishes a monitor report
on the key indicators of each programme.
These monitors are prepared by independent external parties.
They are used for accountability
and for checking the effectiveness, quality and affordability of the programmes.
The centre also commissions scientific evaluations from external research parties.
Strategies for optimisation, explanation of trends and long-term revenues of the centre
are regularly evaluated to improve the screening programmes.
The centre is in charge of balanced communication with the public,
with professionals and with stakeholders.
The Centre for Population Screening is responsible for providing folders
to invitees and professionals.
Information in these folders should be balanced,
so invitees can make an informed decision on whether or not to participate.
The folders are always pretested, using a panel of target group representatives.
The centre also actively updates online information,
follows social media and responds to social media.
The centre furthermore pools knowledge from its broad network
and guides innovations throughout this network.
The broad network is proactively maintained.
Together with many partner organisations, the centre produces and pools knowledge,
and provides access to the knowledge and expertise required
to implement screening programmes.
Together with partner organisations, the Centre for Population Screening
signals, prepares and implements new programmes,
and adapts existing programmes on an ongoing basis.
The centre takes the lead in implementing major innovations
and introducing new screening programmes.
It ensures that they are introduced according to the latest insights
within the existing infrastructure.
Last but not least, the centre advises and informs policymakers
from the Ministry of Health, Welfare and Sport on the latest issues.
The Centre for Population Screening ensures
that government policy is implemented.
But also that knowledge and developments from every day implementation
are channelled back to policymakers.
The centre considers it an honour
to coordinate the seven national population screening programmes
and is dedicated to carrying this out in a professional, business-like way.
Thanks to the joint efforts
of all the collaborating organisations and their professionals,
the Centre for Population Screening directs and coordinates
the seven population screening programmes
with great passion, expertise and transparency.
The centre hopes to continue to deliver an important contribution
to public health in the Netherlands.

(On-screen text: The Dutch National Population Screening Programme. RIVM Centre for Population Screening. 'Balance is Coordination'.)

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