Integrated approach to strengthen healthcare workforce in Caribbean part of the Kingdom

THE HAGUE--The Minister of Education, Culture and Science, Gouke Moes, has informed the House of Representatives about an integrated, program-based approach to help address growing pressure on the quality and accessibility of health care in the Caribbean part of the Kingdom, driven by population aging and rising care demand. The update was provided in a letter issued jointly with the State Secretary for Youth, Prevention and Sport and focuses on improving the full education-to-employment pathway for future health professionals, with the goal of increasing capacity and encouraging graduates to return to the region.

Building on earlier commitments referenced in the July 7, 2024 policy response on challenges facing Caribbean students in higher professional and university health programs, the Ministry is advancing a Kingdom-wide approach in line with the concluding outcomes of the Four-Country Consultation (Vierlandenoverleg). To support implementation, a program manager was appointed in the Caribbean in fall 2025 and will develop a substantive proposal for the OCW/VWS steering group of the Four-Country Consultation on how to expand care capacity in the region.

The proposal covers Curaçao, Aruba, St. Maarten, and Caribbean Netherlands, and is limited to higher professional (hbo) and university (wo) health programs with a numerus fixus, with Medicine identified as the priority. The approach was discussed at the OCW Four-Country Consultation in November 2025 and is supported by all participating countries as a good practice to help reduce brain drain. Parliament will be updated on progress in early 2026 through the documentation of the VWS/OCW Four-Country Consultation.

The Minister notes that extended study and training in European Netherlands can create distance between Caribbean students and the Caribbean health care field, not only physically but also emotionally, as students build personal lives and professional networks in European Netherlands. Because experience in the Caribbean context can be a key factor in the decision to return, the Minister will engage with health education programs in European Netherlands to explore how clinical rotations and internships can be made easier to complete in the Caribbean. In parallel, the program manager will assess practical options within the Caribbean region.

In 2023, the four countries agreed to develop a pathway to improve progression of Caribbean students into medical specialization, both in European Netherlands and in the Caribbean part of the Kingdom. Recent discussions with university medical centers and local care institutions indicate concrete opportunities and broad willingness to train specialists for the region, alongside initiatives that already exist.

A highlighted example is collaboration among Horacio Oduber Hospital (Aruba), Leiden University Medical Center, and University Medical Center Utrecht, where specialists are trained above standard staffing levels for Horacio Oduber Hospital, including arrangements that enable temporary return during training through specific agreements. The Ministry of Health, Welfare and Sport (VWS) is exploring whether a similar approach can be applied elsewhere.

The letter also addresses a parliamentary motion calling for the reintroduction of “ministers’ places” or a comparable arrangement, citing concerns about access and progression for Caribbean students in numerus fixus health programs in European Netherlands. The Minister reports that an extensive civil service exploration was conducted in response.

According to the Minister, data from the DUO Higher Education Trend Report indicates that since the introduction of decentralized selection in 2017, intake of Caribbean students into numerus fixus health programs has declined. At the same time, the Minister states that reintroducing reserved places would constitute unequal treatment between Caribbean students and students from European Netherlands and would require an objective justification under equal treatment law, including demonstrating effectiveness, proportionality, necessity, and the absence of less intrusive measures with similar impact.

The Minister further cautions that reserving places at entry does not guarantee return to the Caribbean care system, and prior research indicated that the majority do not return. Given these factors, the Minister considers it more appropriate to focus in the coming years on the integrated approach and related measures, rather than pursuing an extensive legal change to reintroduce ministers’ places, which are not permitted under the decentralized selection system introduced in 2017 (where central lotteries and ministers’ places were abolished). The letter notes that decentralized lottery has recently been reintroduced as an allowed selection method.

Within the current framework, the Minister points to existing legal provisions under the Higher Education and Scientific Research Act (WHW). Under Article 7.53 WHW, introduced through the Quality in Diversity Act (Wet KiV), institutions must take the interests of Caribbean students into account when designing selection procedures, with the aim of enabling equivalent participation in selection and study choice activities. The Minister states that practice varies by institution and that more can and should be done, and indicates plans to engage institutions directly and emphasize their legal responsibility, noting they educate for the entire Kingdom.

In addition, the Minister is working on legislation to require institutions to better substantiate and increase transparency of selection procedures, with attention to proportionality and whether the investment demanded of applicants is in reasonable balance with expected benefits for students and institutions. Institutions would also be required to explain how they meet their obligation to consider the interests of Caribbean prospective students.

The Minister also emphasizes the need for improved study choice and selection information in the Caribbean, given barriers to attending open days and participating in on-campus activities from abroad. Through the Kingdom-wide Strategic Education Alliance (SEA) program, further efforts will be made to strengthen targeted information provision using a broad mix of physical and digital channels.

With the integrated approach and measures to improve selection procedures, the Minister indicates that an alternative package is in place and considers the motion addressed. The effectiveness of the overall approach will be evaluated after three years, and if effective initiatives to increase the inflow of qualified care providers in the Caribbean lag, the possibility of reserved places for Caribbean students may be reconsidered.

Beyond higher education, the letter outlines collaboration between the ministries of OCW and VWS to better align vocational education (mbo) with the Caribbean labor market. Following the Ministerial Four-Country Consultation, a project leader was appointed to launch Doctor’s Assistant and Pharmacy Assistant programs on Bonaire, Aruba, and Curaçao starting in August 2024. The longer-term goal is durable regional cooperation among care and education institutions across the four countries to embed these programs in the region, with the pilot intended to generate lessons for other education needs and the concept of a Caribbean education region.

The approach is inspired by the training pathway for Central Sterilization Department staff (CSA), a collaboration among hospitals in Aruba, Curaçao, and Bonaire and Summa College, which has been operating since November 2023 with high satisfaction.

The letter also notes that, from September 2025, MBO Bonaire launched a Lifelong Learning (Leven Lang Ontwikkelen, LLO) program offering short learning modules leading to official certification, expanding beyond full-time programs and work-study pathways. The Minister frames LLO as an important step toward flexible, practice-oriented adult education that supports workforce qualification and labor market alignment.

Finally, the Minister states that training within the Caribbean region reduces the risk of brain drain and supports retention of talent, knowledge, and skills, and adds that existing cooperation offers a foundation for potential future regional collaboration in higher education health programs, supported by an already established higher education consortium with participating institutions from across the Kingdom.

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