From local milk banks to a coordinated national system: policy innovation, quality harmonisation and early outcomes of Belgium’s donor human milk programme (2023–2025)

Human milk provides critical benefits for preterm and medically vulnerable infants. To improve access to donor human milk (DHM), the Belgian Federal Public Service of Health supported the establishment of two external DHM banks in 2023: DONEO (UZ Leuven) and the Banque de Lait Belge (CHU Liège). These banks are responsible for donor recruitment, milk processing and distribution to NICUs throughout Belgium and operate within a unified national quality framework that harmonises donor screening, processing, traceability and distribution. Hospital-based internal milk banks continued to provide donor milk locally within the same framework. This study evaluates the feasibility and early implementation outcomes of the national DHM system. This descriptive implementation and feasibility study analysed programme data from the two external DHM banks, internal milk bank activity reports and national quality guidance between 2024 and 2025. Outcomes included implementation of national quality standards, donor recruitment, milk processing activity, traceability systems, infrastructure development and early national distribution capacity. Establishment of the national DHM network proved operationally feasible. During the foundational phase in 2024, both external banks developed infrastructure, donor recruitment pathways, traceability systems and harmonised quality procedures. Liège registered 87 donors and collected 549 L of DHM, while Leuven completed infrastructure development and collected 175 L from 22 donors. Internal milk banks processed an additional 580 L. In 2025, both external banks operated at national scale. A total of 256 donors were screened, contributing 1,598 L of raw milk, of which 1,040 L was approved for clinical use. Both banks implemented validated temperature-controlled transport, standardised bacteriological testing and comprehensive traceability systems. However, administrative delays in contracting between NICUs and donor milk banks limited early uptake. Consequently, 935 L of DHM was distributed nationally, while internal milk banks supplied an additional 563 L locally, representing approximately half of the estimated annual national requirement. Establishing a coordinated national DHM system in Belgium was feasible despite a complex healthcare governance structure. Early implementation outcomes demonstrate successful deployment of harmonised quality standards, donor recruitment pathways, traceability systems and national distribution capacity. Further follow-up is required to assess the system’s long-term impact on equity of access, service utilisation and clinical outcomes.