In contemporary society and modern livestock farming, a monitoring and surveillance system for animal health has become indispensable. In addition to obligations arising from European regulations regarding monitoring and surveillance of animal diseases, The Netherlands developed a voluntary system for the monitoring and surveillance of small ruminant health. This system aims for (1) early detection of outbreaks of designated animal diseases, (2) early detection of yet unknown disease conditions, and (3) insight into trends and developments. To meet these objectives, a system is in place based on four main surveillance components, namely a consultancy helpdesk, diagnostic services, multiple networks, and an annual data analysis. This paper describes the current system and its ongoing development and gives an impression of nearly twenty years of performance by providing a general overview of key findings and three elaborated examples of notable disease outbreaks. Results indicate that the current system has added value to the detection of various (re)emerging and new diseases. Nevertheless, animal health monitoring and surveillance require a flexible approach that is able to keep pace with changes and developments within the industry. Therefore, monitoring and surveillance systems should be continuously adapted and improved using new techniques and insights.