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Food safety in low- and middle-income countries: What works, what doesn't and why

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Presentation by Delia Grace, Fred Unger, Hung Nguyen-Viet, Johanna Lindahl, Kohei Makita, Kristina Roesel, Michael Taylor, Ram Deka, Sinh Dang Xuan, Steve Jaffee and Silvia Alonso at the 15th International Symposium of Veterinary Epidemiology and Economics, Chiang Mai, Thailand, 13 November 2018.

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Food safety in low- and middle-income countries: What works, what doesn't and why

  1. 1. Food safety in low- and middle-income countries: What works, what doesn't and why Delia Grace, Fred Unger, Hung Nguyen-Viet, Johanna Lindahl, Kohei Makita, Kristina Roesel, Michael Taylor, Ram Deka, Sinh Dang Xuan, Steve Jaffee and Silvia Alonso The 15th International Symposium of Veterinary Epidemiology and Economics Chiang Mai, Thailand 13 November 2018
  2. 2. Presentation  Why food safety in low-and middle-income countries (LMIC) matters  New findings on food safety  Systematic Literature Review on food safety interventions  What doesn’t work  What may work  Conclusions
  3. 3. Traditional Image of Food Safety Food Safety critical to ACHIEVING the SDGs  Food safety is integral to:  Food safety (practice) contributes to: 3 Food safety is integral to the SDGs The lack of explicit attention to food safety in the SDGs stems from the low evidence base on the burden of foodborne disease and the overall low awareness of development practitioners about the economic significance of unsafe food.
  4. 4. Most FBD caused by microbes Havelaar et al., 2015
  5. 5. Problem: fresh foods in wet markets Painter et al., 2013, Sudershan et al., 2014, Mangan et al., 2014; Tam et al., 2014; Sang et al., 2014 ; ILRI, 2016
  6. 6. Foods implicated - FERG World Health Organisation, 2017
  7. 7. India: 100 million cases per year economic costs USD 12 to 55 billion By 2030 – increasing from 1 in 12 to 1 in 9 people illness/year (ILRI & WUR, 2018) Estimates of numbers of current foodborne disease per year in India It will get worse before it gets better Hoffman et al., 2018
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  9. 9. Main messages When food safety has been on the development agenda, this has primarily been in relation to trade. This needs to change. We often see a policy vacuum and leadership void. Crisis management is more common than risk management. The gap between food safety capacity and actual needs is especially problematic among rapid urbanizing lower middle-income countries. There are appropriate food safety public policies and cost-effective investments for countries at all economic levels.
  10. 10. Domestic costs may be 20 times trade costs Cost estimates for 2016 (US$ billion) Productivity loss 95 Illness treatment 15 Trade loss or cost 5 to 7 ‘Productivity Loss’ = Foodborne Disease DALYs x Per Capita GNI Based on WHO/FERG & WDI Indicators Database Illness treatment = US$27 x # of Estimated foodborne illnesses Trade loss or costs = 2% of developing country high value food exports
  11. 11. • Donor investment since 2010 less than $40 million a year. Small in relation to burden and investments in other health areas • Substantial focus on: • National control systems • Exports and other formal markets • Chemical hazards • • Little focus on: • Market-based and demand-led approaches • Informal sector where most foods are sold • Biological hazards and risks to human health Main messages
  12. 12. 1. Health first: Better address the health of domestic consumers dependent on informal markets. 2. Risk-based: Build capacity for well-governed, evidence- and risk-based food safety systems. 3. Market-led: Harness marketplace drivers of progress on food safety. Call to action!
  13. 13. We can’t regulate our way to food safety Regulations are needed but not enough  100% of milk in Assam doesn’t meet standards  98% of beef in Ibadan, 52% pork in Ha Noi, unacceptable bacteria counts  92% of Addis milk and 46% of Nairobi milk had aflatoxins over EU standards  36% of farmed fish from Kafr El Sheikh exceed one or more MPL  30% of chicken from commercial broilers in Pretoria unacceptable for S. aureus  24% of boiled milk in Abidjan unacceptable S. aureus
  14. 14. We can’t modernise our way to food safety Modern retail growing, traditional persisting  Supermarketisation is slower than thought  Formal sector food is not always safe  Modern business models have often run into problems – Co-ops, abattoirs, market upgrades
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  16. 16. 17 0 10 20 30 40 50 60 70 80 90 100 Poor total bacteria Unacceptable total bacteria Unacceptable faecal bacteria Unaccpetable Staph Unacceptable listeria Any unacceptable Supermarket Wet market Village Pork in Vietnam ILRI, 2013
  17. 17. We can’t train our way to food safety Capacity building useful if incentives in place
  18. 18. 19 Along the value chain Technologie s Training & information New processes Organisational arrangements Regulation Infrastructure Farmer +++ +++ + +++ + ++++ Processor & transporter +++ +++ +++ ++ ++ +++ Retailer + ++ + ++ ++ +++ Consumer + +++ + + + +++ Govt. +++ ++ ++ +++ Population level: •Incorporating food safety into other health programs such as mother and child care or HIV treatment •Medical interventions such as vaccination for cholera or norovirus or binders for aflatoxins •Dietary diversity to reduce exposure and vulnerability to toxins •Water treatment Systematic literature review of food safety interventions in Africa
  19. 19. 20 Outcome measured Number Percentage KAP 25 28 Hazard level or presence 24 27 Indicator of hazard 17 19 WTP 7 8 Health outcome 6 7 Compliance 4 4 Quality attribute 4 4 Infrastructure 1 1 Livelihoods 1 1 Study design Epi Econ Strong 20 2 Weak 34 4
  20. 20. Room for improvement • Failure to evaluate large scale investments • Interventions without measuring outcomes – yet some interventions make things worse • Near-term, easy, un-important outcomes e.g. changes in knowledge • Reliance on self-reporting (e.g. diarrhoea) • Short-term follow ups – no attention to sustainability • Limited information on economic aspects – many unaffordable • Lack of attention to incentives • Limited attention to gender, equity and nutrition
  21. 21. Increasing concerns over food safety Jabbar et al.; Lapar et al. In seven developing countries studied •Many/most reported concern over food safety (40–97%) •Willing to pay 5–10% premium for food safety •Younger, wealthier, town-residing, supermarket shoppers willing to pay more for safety •Buy 20–40% less during animal health scares
  22. 22. Pull approach (demand for safe food) Push approach (supply of safe food) Consumers recognize & demand safer food VC actors respond to demand & incentives Inform, monitor & legitimize VC actors Build capacity & motivation of regulators Consumer campaign for empowered consumers The threefold path to safe food ENABLING ENVIRONMENT
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  24. 24. Experience to date 25 Particulars Kenya Senegal Ibadan, Lagos Assam state, India Kampala Value chain Informal milk sector Goat restaurants Butchers Informal milk sector Butchers When 1997–2006 2010–11 2009–11 2009–13 Ongoing or starting •Dairy traders in Kenya – randomized control trial •Follow up butchers in Kampala •Butchers in Vietnam •Traders in Ethiopia •Butchers in Cambodia
  25. 25. Dairy in Assam • Training on hygienic milk production and handling • Along the dairy value chain: producer, trader • Media and information campaigns • Peer-to-peer monitoring and evaluation • Incentive: good publicity and membership dairy platform 26
  26. 26. • Better knowledge and practices • Fewer cases of mastitis • Higher revenues • Greater consumer trust in milk • 70% of traders in Assam are currently registered • It benefited the economy by $6 million a year in Assam • 1.5 million consumers benefiting from safer milk
  27. 27. Pork value chain in Uganda savings on firewood / month = 900,000 UGX (260 US$) + >100 trees Reach: 50% of all pork butchers/joints and 500,000 consumers in Kampala
  28. 28. Take-home messages  Huge health burden of foodborne disease – Most due to microbes in fresh foods in wet markets – Will get worse before it gets better  Huge economic burden of foodborne disease  Previous investments not in line with modern understanding  Interventions successful in the short term  Long-term, wide-reaching impacts likely require  Training and technology  Incentives  Enabling environment
  29. 29. Thank you to our donors!  BMZ: First donor to support food safety in informal markets  Australian Centre for International Agricultural Research: Safe pork in Vietnam  USAID Feed the Future Innovation Lab for Livestock Systems  World Bank: Policy and projects  Bill & Melinda Gates Foundation and the UK Department for International Development: Evidence and now projects
  30. 30. This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence. better lives through livestock ILRI thanks all donors and organizations who globally supported its work through their contributions to the CGIAR system