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EACEA National Policies Platform:Eurydice
Organisational variations and alternative structures in primary education

Belgium - Flemish Community

5.Primary education

5.4Organisational variations and alternative structures in primary education

Last update: 27 November 2023

Artistic training

Youngsters can receive artistic training in part-time education in the arts (see chapter 8).

Education for pupils absent for medical reasons

In the course of a school year, children may be absent from school due to illness or other medical reasons. An absence of short duration is usually not a problem in terms of school activities. More problematic is when the absence is prolonged or frequent.  The absence then creates a real risk of learning disadvantage. In order to limit this as much as possible, a number of measures are taken with regard to the education of sick children: 

  1. Type 5 education (hospital education)
  2. Temporary Home Education (TOAH)
  3. Education in Services with educational needs (C-services= child psychiatry)
  4. Synchronous Internet Education (SIO, Bednet)

Flanders is a leader in the field of education of children who are absent for medical reasons. All measures relating to education of children who are absent due to medical reasons have two objectives:

  • To limit the pupil’s learning disadvantages.
  • To prepare for the pupil’s return to school.

Contact with the school is an additional benefit but can never be an end goal in itself.

Type 5 education 

A type 5 school is attached to a hospital, preventorium or residential setting. The school’s staff undertake the education for all patients of the medical facility or residential setting. The education provided can be individual (at bedside) or groups or even classes can be formed.

Type 5 schools are schools in the regulatory sense of the word. A package of teaching periods is calculated based on the average number of pupils during the counting period and an average length of stay. The reason for working with an average number of pupils is that pupils who are staying in a hospital, preventorium or residential setting do not necessarily stay there full-time throughout the entire school year. The school has an autonomous board (apart from the director of the facility to which the school is attached) and an administrative framework and operating budget is provided. The school can issue certificates. The teaching staff appointed are teaching staff in the “traditional” sense of the word (performance arrangement of the education, fixed appointment, remuneration). There are both primary and secondary type 5 schools. Since September 2014, all secondary departments are connected to an autonomous type 5 school with its own board.

Despite the fact that type 5 schools are “normal schools” in a regulatory sense, there is a big difference with regular education: the approach and the intensity of the education supervision is totally different because they work exclusively with sick pupils. The objective of all these schools is the same: restrict the learning disadvantages and ensure a smooth return to (home) school.

The possibility of setting up a type 5 school in a residential setting is relatively new (M decree). “Residential setting” is deemed to mean various welfare, youth and health provisions, other than hospitals and preventoria, where children and young people are admitted and supervised and for whom it is therefore not possible to follow education in a school and are in need of education (for example: counselling homes).

The Government must stipulate other categories of provisions that will be viewed as residential setting (and where, after permission from the Government of Flanders, a type 5 school could be set up). When determining the categories that could be considered as a residential setting, the Government will take into account the size, characteristics, length of stay and regime of the target group and specifically of the residential setting.

In 2019, the educational landscape has seven type primary schools of type 5, with a total of fifteen locations:

  • three primary schools are connected to university hospitals (Antwerp, Ghent and Leuven), offering eight locations;
  • two are connected to rehabilitation clinics (Pulderbos and Vlezenbeek) with a total of three locations;
  • two belong to the preventorium in De Haan (one French-speaking and one Dutch-speaking, each with two locations).

Pupils are registered in both the home school and in the type 5 school. Use is made of a double registration (this is the only situation whereby double registration is permitted) as well as double counting. The home school therefore has the obligation to cooperate fully in the education that is provided to its pupil in this way.


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Temporary education at home (TOAH)

Temporary Home Education (TOAH) was introduced in 1997 with the Nursery and Primary Education Decree. Since then, the right to temporary education at home has been optimized, the target group expanded and the measure has been adopted by secondary education.

TOAH is organized for pupils in the regular and special educational needs system (SEN) who for medical reasons are absent from school for long or frequent periods. There are three important target groups for TOAH:

  • pupils absent for long periods due to illness or accident (“not chronic") (approx. 80% of TOAH applications);
  • pupils who are absent frequently and repeatedly (“chronic”) due to sickness or accident;
  • pupils on maternity leave (only in secondary education).

The general basic conditions to be entitled to TOAH are:

  • the pupil concerned attended funded or subsidized education;
  • the pupil is at least 2.5 years old;
  • an application has been submitted by the parents, which is reported to the school management team of Agodi by the school. In that application, the parent (the person concerned) asks the school to organize TOAH. In that application, the doctor certifies that the pupil is ill and cannot go to school but that TOAH can be granted.

In addition to these general binding conditions, there is also a condition concerning the distance from the school. The distance between the school (the most favourable location of the school for the pupil, not necessarily the one where the pupil takes lessons) and the residence of the pupil may not be more than 10 km for normal education and no more than 20 km for special educational needs education. If the pupil’s place of residence is more than 10 or 20 km from the school, the school is under no obligation to organize TOAH. If it wants to, it is allowed to do so. The school can be expected to treat pupils who live outside this radius equally. If they give TOAH to pupil A who lives outside the kilometre radius, they are expected to organize this for pupil B who lives outside the kilometre radius.

In addition to general conditions that apply to everyone, there are specific conditions for the various target groups:

  • the acquisition of the right (the ticket, the conditions);
    • an absence of longer than 21 successive calendar days due to illness or accident for pupils who are not chronically sick, certified by a physician/GP or for maternity leave, certified by a physician/GP;
    • a certificate from a specialist physician monitoring the chronically sick pupil (there is no waiting time for these pupils);
  • generating the supplementary framework;
  • the use of teaching periods.

If the pupils meets the conditions, the start of the procedure for TOAH can be requested. The pupil’s parents request TOAH from the director of the home school using a standard application form. In the event of long-term illness or an accident, a sickness certificate is issued by the GP or the physician valid for one school year per school. In the event of a chronic illness, the specialist issues the certificate. This certificate remains valid throughout the school career. TOAH is offered at the pupil’s place of residence. The school decides as to the content of the TOAH in consultation with the parents and where possible with the pupil concerned and at best (where available) after consultation of T5 school or DMOB. The time will be agreed in mutual consultation. In addition to the remuneration for the teaching periods, the Government also pays transport costs for the pupil.

After 21 calendar days of absence for long-term sickness, the pupil generates four teaching periods. Each week (after the 21 calendar days) whereby the pupil can attend school for less than half the time, another four teaching periods are generated.

For each period of nine half days of absence from school due to chronic illness, certified by a specialist physician, four TOAH teaching periods are also generated. These half days can be spread over the entire school year.

TOAH can take place either at the pupil’s home or at school. This latter is being introduced for chronically ill pupils. TOAH can also be combined with Synchronous Internet Education. It is, however, not possible to organize TOAH in a preventorium, hospital or residential setting when type 5 education is organized or a DMOB.


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* number of pupils receiving TOAH

K-servives and DMOB

Child and adolescent psychiatric facilities (K-services) that are part of a hospital, which is not served by a type 5 school can be recognized as a service with educational needs (DMOB). The K-service is funded to ensure an educational offer within the facility. The pupil involved remains registered in the home school throughout the period of stay in the K-service and the education received from the DMOB. The pupil is, after all, absent due to a doctor’s certificate. The home school therefore has the obligation to cooperate fully in the education that is provided to its pupil in this way. The pupils concerned generally spend a long period in the K-service (several weeks to months).

Unlike type 5 schools, a DMOB is not a school in the regulatory sense of the word: there is no director position, there is no distinction between primary and secondary education and the service cannot issue any certificates. The courses are organized throughout the calendar year; there is no school year. The Education Inspectorate is responsible for quality assurance.

DMOBs receive a subsidy. The choice was made for envelope financing calculated based on the number of recognized beds for day and night hospitalization and/or places for daytime hospitalization on 1 January of the current school year. A total amount for all DMOB is included in the decree; this amount is divided by the total number of beds and places to be funded in order to ascertain the amount per bed/place. Envelope funding gives the DMOB the possibility to react as flexibly as possible to the changing educational needs within the institution. With the allocated subsidy envelope, they can employ staff on a permanent basis, conclude partnership agreements with schools, pay external employees or undertake a combination of all these possibilities.

In recent years, various facilities have paid increasing attention and care to mutual networking and adjusting their offer for children and adolescents with a highly increased mental vulnerability. More and more facilities are bundling their strengths in order to offer these young people the appropriate help. And yet the Care and Health Agency concluded that there is still not the necessary care available for some adolescents. Flanders is therefore working on a reconversion exercise whereby hospitals can reconvert their (existing and recognized) general hospital beds to child psychiatric f(d) and/or k(n) places. With this exercise, Welfare hopes to achieve an additional capacity of more than 120 K-day places and 11 K-night places in Flanders. There is a strong belief in a concept of small-scale units, close to children and adolescents and their facility, their school, hobbies, etc. and connecting closely to other sectors.

Despite this reconversion exercise, the number of K services with DMOB has declined in 2019 as well as the number of places for which this is organized. On 1 September 2018, a number of K services made the transition from the DMOB funding mechanism DMOB to type 5 education. In the years ahead, the number of K beds will once again rise as a result of the reconversion exercise.


K-services subsidised as DMOB: 9

Number of beds: 173 beds

Amount per bed: 5.606,87 EUR

Synchronous Internet Education (SIO)

Synchronous Internet Education (SIO) is a specific from of distance learning, whereby a young person is physically incapable of being present in class and yet can participate in the class event “in real time” by means of and supported by ICT applications. SIO offers pupils who find it temporarily impossible to attend school due to illness, accident or maternity have the possibility of participating in lessons via computer, directly and in interaction with the teaching staff and fellow pupils. SIO supports the learning process, limits learning disadvantage and prepares for a return to school. SIO can be combined with TOAH.

It was decided to work with a central organizer for SIO. This central organizer Bednet, was appointed by means of a procedure. The following tasks will be undertaken by Bednet as central organizer:

  • capturing the requests for SIO via a web application;
  • assessing the applications for SIO (formal conditions and feasibility);
  • making a consultant available who starts, monitors, supervises and facilitates the SIO process;
  • making material available for 700 simultaneous SIO projects and reaching 1,000 pupils per year;
  • offering a helpdesk function and technical support;
  • actively working on raising awareness of the SIO measure (for example: the annual pyjama day);
  • material and methodology development, research and education. Within SIO, technology in both hardware (for example: use of cameras) and software (for example: access for small children who cannot (yet) read well, connections (speed test)) assume a very important position.

The sick pupil who wishes to make use of the CIO must meet a number of formal and substantive criteria. The formal criteria are as follows:

  • the pupil is at least five years old and is a regular pupil in funded or subsidized primary or secondary education;
  • a pupil cannot be supported in the same period by both SIO and Permanent Home Education (POAH). A combination with Temporary Home Education (TOAH) is possible (and even recommended);
  • the pupil is temporarily, extensively or frequently incapable of attending education in their own school due to illness, accident or maternity leave. The school has documents that account for his absence;
  • if the absence is due to illness or accident, SIO is compatible with the medical treatment of the pupil.

In terms of content, the pupil must meet the following:

  • Can the pupil, during the period of absence, learn sufficiently and interact via SIO? SIO is direct. The pupil must be sufficiently capable of making use of the teaching moments of SIO.
  • In the event of a lengthy absence, a minimum planned absence of 4 weeks is proposed. In the event of a frequent absence, a minimum planned absence of 36 half days per year is proposed.
  • The pupil, his parents, the school and the CLB all show involvement and commit themselves in a positive way.
  • SIO will not be used to keep the pupil at a distance.

After Bednet has received the application, the consultant will reserve five days for contact during the school year with the family and the school. The consultant is the point of contact for all parties involved concerning SIO and actively supervises the preparation, start up and completion of an SIO project, both in terms of content and organization. This takes place in close cooperation with school, family and any others involved, whereby the possibilities of the situation at home and school are taken into account. The consultant strives for a maximum protection of the privacy of all parties involved and will always act accordingly.

Schools are obliged to report SIO in their school regulations. The school must inform the parents individually of the existence and possibilities of SIO, once it becomes clear that the pupil will be eligible for this.

Non-profit organization Bednet provides customized guidance to the sick pupil by creating a virtual school environment and offering this via the Internet. This is a user and child-friendly solution that offers a number of possibilities within compulsory education. A computer in the class of the sick child can be connected with the computer at home or in the hospital. Using a laptop and peripherals, he or she follows everything that happens in class. The pupil is involved in the lesson via a camera and can talk to his classmates and ask questions. The pupils sees his teacher and classmates in class. He can take photos of the board and, by using a bell, can attract the teacher’s attention; it is even possible to put up his hand. This system allows customized lesson material, tasks and tests, messages and audiovisual material to be offered to the pupil.

Thought has also been given to children who cannot participate in lessons during the day. In that case, the teacher can store the agenda, subject material and assignments in the bookcase so that pupils can retrieve everything after school hours.

All the technical material needed for implementing Synchronous Internet Education is currently being made available free of charge by Bednet. The sick pupil acquires all books and papers that are necessary for him to follow the lesson.

In the 2006-2007 school year, Bednet started a number of trial courses. SIO was “put on the map” by the non-profit organization. The history of Synchronous Internet Education in Flanders is inextricably linked to the history of the non-profit organization. The first complete school year was 2007/2008. Bednet was funded from the very start by the Government. Until 2015, the subsidy from the Government of Flanders was around EUR 237,000 annually.

In the decree of 25 April 2014 concerning Education XXIV, Synchronous Internet Education was anchored by decree from 1 September 2015 onwards. The subsidy was raised to EUR 2.3 million. Since the allocation of this higher subsidy, there have been concrete agreements reached between Bednet and the Government of Flanders about the performance and very significantly, about the range of the target group.

Throughout 2019, the process has been commenced to work with a multi-year grant agreement with the central organizer. This grant agreement will operate on the basis of the school year, while the current funding agreement works based on the calendar year. The “vacancy” of central organizer will be reopened when transitioning to this multi-year grant agreement.


Evolution of the number of pupils that make use of SIO

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POZILIV stands for Platform voor Onderwijs aan Zieke Leerlingen in Vlaanderen [Platform for Education to Sick Pupils in Flanders]. This platform champions high-quality educational support and guidance of sick children and adolescents. In their memorandum, they dedicate themselves to improving the care of chronic and long-term sick pupils. They want to see a number of complaints in the field of education resolved based on concrete proposals.

The administration regularly consults with representatives of the platform.