Table 1.

Categories of human milk bank operational models utilised around the world (PATH, 2019a).

Financial structure
Nonprofit	Commercial, for profit
Most human milk banks (HMBs) are nonprofit entities. Primary goal is to promote and support breastfeeding by providing safe, high‐quality DHM to fill a gap for infants who need MOM but cannot receive it. Donor human milk (DHM) is usually donated voluntarily; expenses may be reimbursed. DHM is provided to facilities or families with processing fees billed to offset HMB operation costs; costs may also be covered by the government, facility, or other funders.	Relatively few in number. For‐profit systems may also include organisations that collect and process DHM for resale (though these may or may not explicitly refer to themselves as “human milk banks”). Donors are usually compensated for milk donation (about US$1 per ounce in the United States). DHM is sold to facilities or families. Some companies claim stricter standards than nonprofit HMBs (such as sterilisation or DNA matching of the donor and her breastmilk).

Oversight structure
Centralised	Decentralised
DHM collected throughout a region is processed in a central facility. Processed human milk is allocated to multiple health facilities.	DHM is collected and processed at multiple HMBs throughout a region. Processed DHM may be used within the facility where the HMB is located or allocated to one or multiple other facilities.

Facility location
Hospital/facility‐based	Community‐based
HMBs are located within a hospital or health facility, most often within a neonatal ward. Donor recruitment often occurs within the facility; mothers are invited to donate for other infants, though community donation may also occur. DHM collected by the HMB is used within the facility or transported to other facilities. Direct support for breastfeeding and kangaroo mother care is possible due to an HMB embedded in the hospital.	HMBs operate independently from any health facility. Recruitment occurs via word of mouth, health professional referral, or active community education or recruitment. DHM collected is allocated to multiple hospitals/facilities or families. Often do not have direct contact with DHM recipients since they only directly provide DHM to hospitals or care facilities; limited ability to engage in breastfeeding promotion.

Vertical and integrated systems
Independent/vertical system	Integrated system
Can be hospital or community‐based. May adapt published technical guidelines from other nations/regions or develop independent guidelines. Usually do not provide breastfeeding support, advocacy, or promotion. Successes are often limited without the infrastructure, planning, support systems, and sustainability efforts built into a more comprehensive approach.	HMB is assimilated into maternal and neonatal care systems; strengthens systems to provide equitable and comprehensive newborn care (Berkley et al., 2014; Bhutta et al., 2014). Aims to protect, promote, and support breastfeeding for all mothers; provides support for breastfeeding and kangaroo mother care for all mothers. Promotes an exclusive human milk diet in the health care setting and throughout the community.