Human M ilk Banking: Successes and Challenges

1. Human Milk Banking: Successes and Challenges

2. Successes: Policy • Government backing • National and regional policies and guidelines developed • Funding support • Facility backing and engagement • Interdisciplinary teams for optimizing human milk nutrition • Advocacy and awareness raising • HMB and breastfeeding promotion • Mass media/peer-review journals • Recognition of successfully implemented system • Integration of messaging • Neonatal care guidelines include DBM • Impact on breastfeeding practices • Health system cost-savings • Adoption of system to other NICUs

3. Successes: Operational • Impact on breastfeeding • Provision of DHM results in increased initiation of breastfeeding in the NICU units • NICUs with highest BF rates have attached HMB • BF rates higher than formula in discharged NICU infants • Increased BF duration among donors • Long-term continuous operations • Improved health outcomes • DHM and supplementation of MOM • Leveraging support from volunteer blood/tissue transport services (bikes, motorcycles) • Integrated/holistic approach through HMB providing lactation support and assistance

4. Successes: Technological • Improved screening, processing, tracking • Refined and/or simplified systems/equipment/supplies • Ability to assess macronutrient and protein content • Validated systems • Online accessibility • Screening, marketing, ordering, prescriptions • Standardized quality assurance and outcome reporting

5. Challenges: Policy • Achieving policy level support • HMB and supporting breastfeeding, ie MOM, lactation support • HMB integrated into other health programs • Implementing legislation to regulate and standardize HMB • Uncertainty of DHM importance among health care staff • Establishing sufficient donor base • Balancing promotion of DHM and capacity to meet need • Supply and demand

6. Challenges: Policy • Limited/no financial support from government • Limited/no leadership or interest from government • Economic crisis • Becoming established as regional centre of reference • Expansion to other areas limited by cultural/tribal concerns • Lack of insurance coverage • For profit and casual sharing impacting donor base

7. Challenges: Operational • Identifying and retaining qualified staffing • Depending volunteers not sustainable • Lack of funds for salaries • Refresher trainings needed • Inadequate training • Need to develop HMB specific training program • Insufficient donor milk due to insufficient donors • Lack of breastfeeding promotion and support • For profit and informal milk sharing impact donor base • Lack of eligible donors due to high HIV prevalence • Maintaining consistent demand for DHM from hospitals to enable growth

8. Challenges: Operational • Implementing transport for milk collection • Implementing a communication plan • Need low cost distribution methods • Need protected and effective on-line screening process • Centralized care model changing to accommodate other level III NICUs • Increased demand could be seen as opportunity for strengthening preterm lactation success • Limited space • Implementing HACCP

9. Challenges: Technological • Achieving optimal pasteurization throughput balanced against wastage • Matching batch volumes with distribution volumes • Need for pasteurizing small volumes • Time for processing • Defrosting takes a long time • Introducing electronic testing and reporting systems, bar code tracking systems • Need for improved pasteurization systems to preserve nutritional and immunological properties – balanced with microbial safety

10. Challenges: Technological • Low cost bottling units that do not retard or chip • Low cost standard methods for testing human milk • medications, contamination and nutritional analysis • Shipping units specifically for human milk • Mechanized processing equipment • Provides homogenized milk • Pouring accuracy