Can Japan's Human Milk Fortifier Policy Improve Preterm Care in Africa?

Africa bears the highest burden of preterm births globally, yet access to donor human milk and human milk–based fortifiers remains extremely limited. Human milk fortifiers (HMF) are nutritional supplements added to breast milk to meet the specialised needs of premature or low-birth-weight infants. A Phase III clinical trial in Japan found that very low birth weight infants who received human milk–based fortifiers achieved better weight gain and improved growth in length and head circumference without increasing the risk of necrotizing enterocolitis (NEC), one of the most serious complications of prematurity. Because the first weeks of life are critical for brain development, improving nutrition during this period may contribute to better long-term cognitive and motor outcomes. Now, Japan has become the first country to classify human milk–based fortifiers as reimbursable prescription medicines rather than nutritional supplements. This landmark decision improves access for premature infants by ensuring that these specialized products are covered under the national health insurance system, reducing financial barriers for families.

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While Japan's reimbursement model demonstrates how national policies can improve access, simply importing expensive commercial fortifiers is unsustainable for most African health systems. In Cameroon for instance, HMFs are not stocked on pharmacy shelves and can only be procured through specialised networks. The biggest barriers include the high cost of commercial fortifiers; cost per box ranges from 35,000 FCFA to over 100,000 FCFA depending on the brand. Limited human milk banking infrastructure, inadequate regulatory frameworks, shortages of trained neonatal nutrition personnel, and low public awareness of formal donor milk banking equally contribute to the access challenge. Although informal milk sharing has existed in many Cameroonian communities for generations, organized donor milk banking is still unfamiliar and may face cultural or religious concerns if not introduced through community engagement.

Recommendations for African Health Systems

Rather than relying on imported products such as Similac, Enfamil or Nestle PreNAN HMF, we should prioritise the establishment of regional donor human milk banks that can safely supply multiple neonatal intensive care units. A hub-and-spoke model, where one well-equipped milk bank serves several hospitals, would be more cost-effective than requiring every hospital to operate its own facility.

Existing maternal and child health programmes, particularly the WHO/UNICEF Baby-Friendly Hospital Initiative, should be used to integrate donor milk services into routine newborn care instead of creating parallel systems. At the same time, expanding training for nurses, midwives, and lactation support staff would strengthen the workforce needed to safely collect, process, and distribute donor milk.

Financing will also be critical. Governments should explore public-private partnerships, South-South collaboration with countries that have established milk banking programmes such as South Africa and Brazil, and the inclusion of neonatal nutrition services within national health insurance schemes.

Finally, community education should accompany these investments to build public trust in donor human milk, address cultural and religious concerns, and promote its role as a safe, evidence-based intervention for protecting the health and development of vulnerable preterm infants.

While Cameroon may not yet be ready to replicate Japan's reimbursement model, investing in donor human milk systems, workforce capacity, and supportive policies offers a practical pathway toward improving survival and long-term outcomes for thousands of premature infants across the continent.