Three-legged stool model for improving food safety in informal markets in LMICs

Informal markets are the primary sources of fresh and nutritious food for most poor populations in low-middle-income countries (LMICs). Additionally, they are the main outlet for smallholder farmers, a source of employment for women and youth, and can improve the liveability and sustainability of cities when they are well-kept and waste well-managed.

Foodborne diseases (FBD) are rampant in LMICs, causing a huge burden of human illness estimated at USD 95 billion in the form of productivity losses, medical expenses, and trade losses. The burden of food safety is equated to the burden of the “Big Three”, namely Tuberculosis, Malaria and HIV/AIDS. However, investment in food safety has remained minimal. Poor food safety in informal markets is evidenced to contribute to this burden. Nutrient-rich foods such as animal-source foods, fruits and vegetables sold in these markets, are the most risky and account for a greater proportion of the FBD burden.

In a recent study, a PhD student and team of Scientists from the Swedish University of Agricultural Sciences (SLU) and the International Livestock Research Institute (ILRI) conducted interviews with stakeholders in the food chain in Kenya, to discuss the status and future opportunities for food safety in informal markets.  Further, two workshops with multiple stakeholders in the food chain were organized in rural and urban Kenya to validate the findings of this study. During the workshops, participants were divided into groups and tasked to discuss current gaps hindering food safety practices and possible intervention strategies. Investing in infrastructure, policy, capacity building, and hygiene and sanitation practices in a multi-stakeholder approach can help improve food safety. The recommendations obtained from the interviews and workshops align well with expert advice that promotes a three-legged stool model to improve food safety in LMICS.  This model represents a balanced and holistic three-leg framework for addressing food safety challenges and ensuring the sustainability of intervention strategies.

Training and technologies involves strengthening capacity among food handlers and consumers through training, knowledge creation and use of simple techniques to combat food safety risks and foodborne diseases.

In Kenya, training among dairy actors has been carried out, through the government oversight body, Kenya Dairy Board. In a study in Burkina Faso, a sample of poultry farmers and vendors were trained on food safety and antimicrobial use to improve knowledge and practice of food safety. Training among pig slaughterhouse workers and owners in Vietnam showed a significant reduction in bacterial load in the meat.

Additionally, this leg also entails providing simple and user-friendly infrastructure and technologies. For example, easy-to-clean table counters, colour-coded containers, and cleaning towels to separate raw from cooked, wearing clean protective garments, and having handwashing stations close to pork selling areas are simple interventions that have been employed and proved to be effective in a study in Vietnam. In Kenya and Tanzania, simple lactometer gadgets to test milk adulteration at milk collection centers have been adopted for use. These techniques and practices are anchored on the five keys to safe food proposed by WHO  and principles of Good Hygiene Practices  under Codex Alimentarius. Training and technologies employed must not only be simple and easy to use but also culturally and gender-sensitive to ensure participation of women, who are most often left out.

Enabling environment. Food safety interventions’ sustainability and long-term effectiveness require support from local authorities and private entities. Local and national authorities need to support food safety through investment in basic infrastructure, policy and regulation, capacity building and monitoring and surveillance activities. In some LMICs, food safety laws are generally absent or remain vague and disabling to informal markets. Providing contextualized and enabling policies and regulations for the different food value chains, especially those considered the most risky, can enhance surveillance and enforcement efforts. In Nigeria, for instance, a training intervention for slaughterhouse workers was found to have been short-lived due to poor policy environment and support.

Promoting public-private partnerships (PPPs) and multi-stakeholder collaboration through investment and capacity building can ensure the lasting impact of food safety strategies. In Burkina-Faso, a multistakeholder group of individuals was selected to act as food safety champions. Their main responsibility was to ensure good practices were reinforced after training poultry meat vendors.

Motivation and incentives are based on Nudge theory, a behavioral science using “nudges” or gentle push towards the desired behavior. This has been employed widely in commercial as well as political settings. Nudges include posters as reminders, using default settings in the food business that promote food safety practices, social influence through positive peer pressure and peer-to-peer accountability, and promoting salience by making the desired behaviour prominent.

On the other hand, incentives are rewards for practicing the desired behavior.  These can be material, social or moral.  Material incentives refer to the returns from more profitable businesses, a certificate of training which can be displayed within the business premises or increased customer flow. Social incentives, on the other hand, include gaining the trust, respect and good reputation of clients and recognition from oversight bodies. Moral incentives can come in the form of feeling proud of providing safe food and contributing to reduced foodborne disease incidences.

Conclusion

Most foodborne diseases are preventable and can be alleviated by good hygiene and safety infrastructure and practices. While some infrastructural investments require huge economic resources, simple measures, tools and techniques that are literally and economically within reach for informal actors also come in handy. Overall, the success of food safety efforts requires active participation and responsibility of all stakeholders in the food chain.