A Proposed Framework for Ranking and Prioritizing Food Safety Risks in Low Resource Settings Using Foodborne Disease Burden Metrics: A Case Study in Ethiopia.

Risk-based food safety systems are recognized as the best way to address food safety in an effective and efficient manner. Central to risk-based food safety systems is an assessment, ranking, and prioritization of risks associated with foodborne hazards that informs objective, evidence-based decisions on risk mitigation in a systematic and transparent manner. While the importance of such approaches is well recognized, many governments struggle with where to begin. We adapted and implemented a framework for risk-based decision-making in low resource settings using Ethiopia as an example, engaging Ethiopian stakeholders in a multi-phase process to identify food safety priorities. First, stakeholder representatives were engaged to define statements of concern and purpose; identify foodborne hazards of public health relevance in Ethiopia; and select appropriate risk metrics for risk ranking and prioritization. Second, estimates for each risk metric were calculated for selected foodborne hazards using World Health Organization (WHO) data and expert elicitation. Third, stakeholder representatives were engaged in ranking the hazards as High, Medium, or Low risk; notably, mortality was the preferred risk metric in decision-making. Fourth, attribution estimates to food groups were developed for hazards ranked as High risk using expert elicitation to supplement WHO data. Lastly, stakeholder representatives were engaged in a risk prioritization exercise that identified key control points in four food supply chains and quantified their impact on risk through mitigation of hazards or prevention of contamination. Our proposed framework provides a systematic, evidence-based and adaptable method for prioritizing allocation of public sector resources. The process can generate the evidence needed to strengthen regulatory systems and support efficient implementation of national-level food safety strategies that span from farm to fork to improve public health.