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Strengthening Systems to
Ensure Equitable Access to
Human Milk: A Resource
Toolkit for Establishing and
Integrating Human Milk
BankingBreastfeeding Innovations Team
Webinar
28 February 2019
Kiersten Israel-Ballard, Associate Director
Kimberly Mansen, Program Officer
Maternal, Newborn, Child Health & Nutrition
A shared vision
Imagine a world where all infants have access to human milk.
PATH/Gabe Bienczycki
PATH is a leader in global health innovation
…to save the lives
of women and children.
We harness ourentrepreneurial insight, scientific and public health expertise, and passion for health equity…
Maternal, Newborn, and Child
Health
Nutrition
Early Childhood
Development
PATH key focus areas: improving nutrition and
newborn health
We have a unique role as catalyst, convener, and global leader
in newborn, nutrition, policy/advocacy, and innovation.
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22 countries with high newborn mortality rates will
struggle to achieve SDG (majority in Africa)
The problem: Every region of the world is experiencing increase in proportion of <5 deaths in the neonatal period
Globally, how will we reach SDG 3.2 newborn mortality target to achieve <12 deaths/1,000 live births by 2030?
Human milk is the ultimate lifesaving personalized
medicine and optimal first food –
innovative strategies are needed to achieve reach
Over 820,000 children’s lives
could be saved annually with
increased breastfeeding rates
Nearly 13 percent reduction in
all under-5 child deaths
Lancet Breastfeeding Series, January 2016
Current systems are not meeting the need – for newborns around the world EVERY MINUTE COUNTS
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How do we care for vulnerable
newborns who don’t have
access to their own mother’s
milk?
Reasons include:
• Mother/infant frequent separation
due to critical care in neonate
ward
• Infant abandonment
• Maternal death, disease
• Delay in milk production from pre-
term birth, insufficient lactation
support, and stress/trauma
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When a mother’s milk is not available: The
challenge of achieving an exclusive human
milk diet
UP TO 40%OF VULNERABLE
INFANTS IN NEONATE
WARDS ARE NOT
RECEIVING FULL FEEDS
OF THEIR MOTHER’S
OWN MILK IN THE FIRST
HOURS, DAYS OF LIFE
(ANECDOTAL REPORTS)
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Historic separation of newborn and nutrition
implementation priorities: A critical
transformation of the field targeting newborn
nutrition is urgently needed
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What is a human milk bank?
Human milk bank: A service established to recruit breast milk
donors, collect donated milk, and then process, screen, store,
and distribute the milk to meet infants’ specific needs for optimal
health.
Processing of donor human milk at a human milk bank
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A multi-pronged approach is needed to ensure
ALL babies everywhere receive human milk
Innovative systems
strengthening is required to
enable and support an
exclusive human milk diet
Supporting needs of mother
and baby
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A decade of intensive learning, collaboration and
focus on strengthening systems for newborn
nutrition
Regional activities:
• South Africa
• Kenya
• India
• Viet Nam
To build capacity,
integrate nutrition,
newborn systems, and
increase rigor to
demonstrate impact
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A global picture: The critical lack of human
milk banks to ensure safe access
Brazilian Network of Human Milk
Banks
>220 human milk banks
~600 human milk banks worldwide is not adequate
Demand far outweighs safe supplyMap in progress- not to be distributed
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Limited global scale-up due to lack of...
Standards Policies
Integration
Data
Innovations
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Global standards for safe establishment and
operations of human milk banks are lacking
• Guidelines on quality assurance for safe donor human milk
are developed at regional levels; massive range in operations
globally
• Systematic platform for communication and sharing of best
practices does not exist
• Integration with breastfeeding promotion is challenging
• Inappropriate/overuse of donor human milk occurs
• Systems level support is needed for enabling mothers to
provide their own milk
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Initial guidance materials developed indicated that a global and comprehensive approach is needed
Modeling
M&E/data
Training curriculum
Quality assurance
HMB best practices
compendium
Social marketing
Policy and ethics
Appropriate-ness
Technical Advisory Group
March 2017:
Global leaders
identify priority
action areas
Multi-pronged approach needed to advance the entire field forward
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Available at: www.path.org/hmb-toolkit
Strengthening Human Milk Banking: A Resource Toolkit
for Establishing and Integrating Human Milk Banks
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Objectives and aim of resource toolkit
• A 22 month process involving workshops with technical experts, pre-testing in
multiple countries and critical review by leaders in the field.
• This toolkit is comprised of 11 separate core documents to guide critical steps
for establishing human milk banking as an integrated component within
breastfeeding support and neonatal care.
• In-depth focus on readiness, quality assurance, operations, auditing, training,
monitoring and evaluation, and communications.
• Accompanying materials, including templates, standards, and tools are
included for direct use.
• These tools are intended to be utilized as a cohesive package, with embedded
links throughout to orient and guide users to relevant resources.
• This toolkit, in its entirety, is freely available and globally accessible. The
content was developed to be adaptable to local context requirements to
maximize effectiveness and reach.
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• Updated Global Implementation
Framework (version 2.0).
• Introductory document on human milk
banking, a comprehensive approach to
integrating HMBs into health systems.
• Serves as the base document for the
toolkit.
• Introduces and links to each of the other
tools in the toolkit.
• Outlines core requirements, quality
principles for HMBs globally.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-0/
A Global Implementation Framework
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Links to other resources within toolkit
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1. An Assessment Tool for Determining Facility Readiness
• Guides facility and clinical leadership
through a process to determine if a
human milk bank is an appropriate next
step to support newborn nutrition.
• Pathway approach guides priority
questions and identifies areas to grow in
preparation for the human milk bank.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-1/
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2.a. Workshop for Developing a HACCP Plan – Trainee Workbook
• Facilitates a workshop to establish
quality and safety, using key safety
measures.
• Workbook walks workshop participants
through establishing a Hazard Analysis
Critical Control Points plan for their
operating facility.
• Also guides existing HMB systems on
improving HMB operations for safety and
quality.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-2a/
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2.b. Workshop for Developing a HACCP Plan – Trainer Guide
• Trainer Guide to accompany the trainee
workbook.
• Guides trainer on key elements for
optimal workshop experience.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-2b/
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2.c. Guide for Creating Operational Standards
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-2c/
• Template for creating locally-appropriate
human milk banking guidelines and
national standards.
• Guides modifications to specify and
incorporate existing local standards.
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2. d. Audit Template
• A template to facilitate self-evaluation
and establish local standards for quality
control.
• Includes guidance sections on standard
operating procedures, staffing,
equipment, and infrastructure, as well as
general processes for safety.
• Additional appendices provide human
milk pasteurizer verification and
performance protocols.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-2d/
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3. Guide for Conducting Monitoring & Evaluation
• Guides the process for establishing
indicators for success, a monitoring and
evaluation plan, and evaluating systems.
• Includes templates and direct examples
(appendices) from past studies for
formative research, and studies before
and after HMB is implementation to
observe impact and changes in neonatal
feeding.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-3/
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4. Training Curriculum Template for Hospital and HMB Staff
• Training curriculum template for local
adaptation for hospital staff in
preparation of the human milk bank
implementation.
• Interactive activities and directions
guides trainer for engaging with the
audience.
• Additional appendices provide guidance
on use proper use of donor human milk,
and an additional training module for
working with bereaved mothers.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-4/
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5. Guide for Track and Trace Documentation
• Provides guidance on creating a tracking
system based on global examples.
• Templates included in the appendices as
example excel forms for adaptation.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-5/
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6. A Guide for Developing a Communications Strategy
• Interactive guidance to establish a
communications strategy aligning with
breastfeeding promotion, build locally
adapted media and communications
tools, and extensive appendices with
examples and templates.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-6/
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7. Counseling Guide for Engaging Bereaved Mothers
• Unique counseling guide for health care
workers engaging with bereaved
mothers on how to counsel them on
lactation, and when appropriate, provide
guidance on donation if the bereaved
mother is interested.
https://www.path.org/programs/maternal-newborn-child-health-and-nutrition/strengthening-human-milk-banking-resource-toolkit-7/
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https://public.tableau.com/views/HumanMilkBankGlobalMap_0/HumanMilkBankGlobalMap?:embed=y&:display_count=yes&:toolbar=no
Global Human Milk Bank Map- Tableau Public
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Thank you!PATH Seattle
Kiersten Israel-Ballard
Kimberly (Amundson)
Mansen
Laura Meyer
Additional Collaborators:Global PATH HMB teams
Ali Demarchis
Gillian Weaver
And:
Global HMB TAG members
EMBA members
HMBANA members
Global technical and policy experts
Interns!
Funding for the development
of the resource toolkit
provided by the
Family Larsson-Rosenquist
Foundation
