Establishing a breast milk bank in Israel - a follow-up meeting
The chairman of the committee, MK Shuli Moalem Rafali
MK Orly Levy Abkasis
MK Nibin Abu Rahmon.
The chairman of the committee, MK Shuli Moalem Rafali: We work together with a small group of MKs on issues related to the health care system in Israel. The question of the establishment and operation of a breast milk bank is related to the promotion of a high-quality and equitable health care system.
MK Orly Levy Abkasis: I entered the topic of activity for premature babies, and became the chairman of the forum for premature babies, following a request from the Lehab association - for premature babies in Israel. They, and Dr. Tsangan, turned my heart to a subject that is not at the center of the stage and therefore does not receive the treatment it deserves. When they showed me the data and explained to me that there was a crisis, for example in the number of neonatologists in the system, I understood that there was a crisis and that it would be a death sentence for premature babies. There was a severe lack of standards and infections Many. I entered this topic with an awareness of what the parents and the family are going through, since my sister gave birth prematurely about 20 years ago.
We were able to declare neonatologists as a profession in distress, and save the field.
Regarding the breast milk bank: in the western world there are regulated breast milk banks. We previously submitted a bill, MK German, the former Minister of Health, said that she had promised a budget for it. We built criteria together with the Ministry of Health. We were supposed to start a pilot, and the health system promised that when everything was settled it would come out in legislation. that on Passover everything will be settled.
I don't care which operator the Ministry of Health chooses. The main thing is that the breast milk bank has started. We are drawn every year. The time has come for the Ministry of Health's commitments to be implemented and for us to see results on the ground. The time has come for us to come with real news.
MK Moalem Rafaeli: It seems to me that everyone here in the room understands the importance of a breast milk bank. I would like to start from the summary that was here a year ago, in November 2017 - that in April 2017 a breast milk bank will be operated in Israel.
We have not been able to get an answer from the Ministry of Health as to where the words are.
Dr. Lisa Rubin, Director of the Department of Mother and Child, Ministry of Health: The milk bank is in the process of being established. The representatives of the Ministry of Health recently visited the bank established by MDA. Due to all kinds of constraints, the process was delayed. But it is progressing. A committee was appointed for this purpose. The agreement between MDA and the Ministry of Health will be signed soon. We hope that within 4 months of signing the bank will be active.
MK Shuli Moalem: I did not receive an answer to my question - what happened from November 2017 to April 2018. The entire process you describe should have already been completed... at least the expectation is that when the committee seeks to understand where we are, you will return a detailed answer.
Dr. Lisa Rubin: There were various reasons, some of them bureaucratic, because of which the establishment was delayed. But now we see the establishment of the bank in practice.
Shuli MK Moalem Rafaeli: Does the Ministry of Health know what it is asking from MDA? What is the expected demand for breast milk in Israel? What is your demand from the hospitals? All this regulation should be dictated by the Ministry of Health.
Dr. Lisa Rubin: The Ministry of Health is drafting the guidelines for establishing breast milk. In collaboration with the Association of Neonatologists.
MK Shuli Moalem: So there is an answer to my question, has the Ministry of Health examined the need for breast milk in Israel?
Dr. Lisa Rubin: No.
Shuli MK Moalem Rafali: I regret that we did not receive responses from the Ministry of Health to our questions and the committee's inquiries.
MK Nibin Abu Rahmon : I expected to hear today about dates and a work plan. And I didn't hear exactly where it stands, and what's the problem? budget? We expect a really clear answer, also to support this.
MK Shuli Moalem Rafali, in her address to the MDA: What is the status from your point of view, what will be the requirements from you from the various hospitals? Mainly asking to understand from MDA what happened with you since April 2018?
Prof. Asher Moser, MDA representative: After the previous discussion a year ago, we turned to the Ministry of Health, we received their blessing to start the process. They promised funding but we started even without their funding, only with the promise that the budget would arrive. So far we have invested between 1 million and 2 million in this process. There is currently a breast milk bank in Romma in Jerusalem, at the MDA branch. The bank meets all the criteria of the circular. There is a manager who was recruited for this position, they were fed with pasteurizers. Additional equipment - computers, refrigerators, milk dispensers - with very high standards compared to the world - is already on its way to us. We believe that the bank will be able to start operating by February 2019. There are still discussions on how the collaborations will be carried out. We believe that the money promised by the Ministry of Health will arrive.
MK Orly Levy Abkasis: If we take the star model, the piglet race model, we see that it works. There is a decrease in infections for example. If, God forbid, the program is affected, the issue of the mother's milk bank can also be affected. Because those hospitals will not invest in the process now. We must have a mother's milk bank stand on two legs, and not depend on one program or another.
Shuli MK Moalem Rafali: What is the bank's operating model?
Prof. Asher Moser: a model similar to the blood bank. It's a procedure that already works. We recommend that the Mother's Milk Ministry set a mandatory price for a unit of milk, and the hospital will have to pay it. In our discussions with the Ministry of Health there is an agreement on support for the establishment and also a commitment to continued support for at least the first five years. We have already started contacting our donors abroad, this is a very attractive project for donors.
Sharon Zabri, MDA: We have started the work and there are advantages to the cooperation with MDA. The disadvantage is the obligation of tenders. And tenders take months. We tried to get an exemption and we didn't. Especially for this project, who assured me that we could establish it at the highest level. The building was built with much higher infrastructure than the required minimum. The equipment, the advice we can get, all at a high level and at a high cost. I hope we got through the hard part of the setup.
Dr. Shmuel Tsangan, Chairman of the Association of Neonatologists, on the state of premature babies today: For over 180 thousand babies born in Israel, breast milk is not food, it is medicine! Dozens of premature babies could have been saved if there had been an active breast milk bank since April 2018.
The bottom line is that we don't feel any activity on the ground yet. A representative of the Milk Bank has not yet arrived for preemies in Israel, to train, to coordinate. No coordinators were appointed or trained.
Shuli MK Moalem Rafali: Dr. Lisa Rubin - who is supposed to appoint and train the coordinators?
Dr. Lisa Rubin: A procedure was issued within the hospitals. Each hospital should establish its own steering committee regarding the use of breast milk.
Dr. Shmuel Tsangan: We haven't heard yet what equipment we need, permanent and consumable. All kinds of things we can already prepare for.
Sharon Zabri, M.D.A: Three weeks ago we issued a document to all preterm managers.
MK Orly Levy Abkasis: I don't understand why MDA and the neonatologists are doing the work of the Ministry of Health. There is a systemic failure here.
Dr. Zimmerman, responsible for mother and child, Jerusalem District, Ministry of Health: I am part of this breast milk bank process. One of the things that Dr. Rubin has done in recent years is to write a new procedure. Because the previous circular was outdated. Now we have to write a new procedure regarding the use of breast milk. There is no point in training adapters before there is a professional agreement on what the requirements are. This is a lot of professional work.
Director of Pagya, Shaarei Zedek Hospital: If the Ministry of Health takes more than a year to publish the procedure, then it will also take time for us, the preemies, to learn the procedure and time to evaluate. If we want to start working and train a steering committee, we need content to give them. We must promote the issue at the same time in several channels.
The managers of the preemies cannot answer the MDA within 5 days, because they are busy with management.
Shuli MK Moalem Rafali to the finance representative: Where do we stand, in terms of establishment budgeting and ongoing budgeting:
Representative of the Ministry of Finance: It was said here that within the Ministry of Health there is a promise to finance the current budget. This will be budgeted as part of the budget discussions. It is important for me to emphasize that a letter has been issued from the deputy in charge of budgets in the Ministry of Finance to all hospitals, including the health system: the cut will not affect public benefit programs, neither preemies nor the breast milk bank.
MK Orly Levy Abkasis: Are you aware that a letter has been issued that talks about another cut? Where will it be cut from?
A representative of the Ministry of Finance: Direct support to the health insurance funds and the hospitals will not be affected by the current and future cuts.
MK Orly Levy Abkasis: I want to understand - in the horizontal cuts you are planning, is the Ministry of Health excluded or not? Where will you cut from? Will you lay off personnel? Will you cut back on computing? Is there always a patient at the end of the chain?
Dr. Golan, Pagia Soroka Hospital: If the hospital does not receive an exact requirement today as to what it needs to purchase for the milk - refrigerators, conveying systems, etc. - we will be in the same situation for another year.
If expired: When my son was in the nursery I pumped milk, when we got home I had a lot of breast milk that I pumped, and he was already nursing, so I had excess breast milk that I had to throw away.
Rumi Shouri, CEO of the LHB association: I have been telling my story for six years. A year ago we left the committee happy and excited for the establishment of a breast milk bank. But unfortunately the bank is still not working, and we still do not have a date for a due date that can receive a breast milk donation. I would like to ask the committee to ask the Ministry of Health to give a deadline and see this bank operating as soon as possible. This is our children. As a head nurse, you must have seen the pain of parents who are on the verge of losing a child. Please let this committee close today with an order to give answers and dates.
... Ministry of Health: A budget has already been allocated for the establishment, and a three-year operation has also been guaranteed for the MDA. Dr. Tsangan and I have been working together for five years. It's easiest to make complaints to the Ministry of Health. You are the professional...
MK Sholi Moalem Rafaeli: Sir, in Israel trade unions do not have the authority to write procedures!
MK Shuli Moalem Rafali, summary of the discussion: We held the debate as part of the due date in the Knesset, a continuation of a series of debates and a legislative process led by Orli Levy Abacsis. The starting point accepted by all is that the breast milk bank is a life-saving medicine in the State of Israel. And from that, it is unclear the dragging of feet, or the apparent lack of progress since last year, and the promise to end the process in April 2018. I understand among whom I am sitting. I know this is a process, regulation, bureaucracy. But I don't understand why we are unable to make progress in these processes: the Ministry of Health's track, the MDA's track, and the training track in the hospitals. The hospitals will not be able to initiate a training process with the Health Ministry not passing procedures and establishing regulation. It is appropriate and right to give gas in the Ministry of Health.
My first requirement is to receive from the Ministry of Health, within 30 days, a schedule. I invite the professionals at the Ministry of Health to say how long it will take for the bank to be established, for the first bottle of breast milk to expire in one of the premature babies.
Regarding MDA: I would like you to try to create some dialogue that will make it clear to us where we are going, what the necessary budget is.
MK Orly Levy Abkasis: requests that the Ministry of Health also forward a list of the equipment needed for operation, so that the hospitals can evaluate in advance. It is my understanding that these things are known to the office.
Shuli MK Moalem Rafali: For neonatologists - I ask that you start preparing the area with your preemies.
Usually those who mark special days here usually hold a discussion and close it on the same day. But I will ask the chairman of the committee to hold a follow-up discussion in the middle of January, about a month and a half from now. I hope that by then we will receive a response from the Ministry of Health, and that the SDMA and Pagyot will be able to tell me what has already been done.
We hear in other discussions, and I also heard now from Dr. Rubin, I suggest to anyone who believes that a breast milk bank is critical in the health care system in Israel, to have an external dialogue as well.