Applying a systems thinking approach to evaluating the effectiveness of Africa's foodborne disease surveillance systems.

Background: Foodborne diseases (FBDs) pose a large public health challenge worldwide, particularly in low- and middle-income countries (LMICs), where limited infrastructure, weak regulatory frameworks, and insufficient cross-sector collaboration hinder effective surveillance and prevention. While previous efforts in Africa have focused on risk identification and management training, these approaches often fail to consider the interconnected nature of risk factors, transmission routes, and systemic barriers. As a result, interventions have had limited impact. Addressing this issue requires a systems approach that accounts for the biological, social, and economic complexities of FBD surveillance.

Methods: We applied the "Five Phase Process of Systems Thinking and Modelling" approach to identify and address the key challenges of implementing effective FBD surveillance systems in Africa. Using leverage point analysis, we identified leverage points with the potential to strengthen the system. We developed and analyzed five scenarios to evaluate the system's performance under various configurations of these leverage points.

Results: Our approach identifies 33 elements and behaviors that are connected in a systems map through balancing and reinforcing feedback loops. We identify three deep leverage points with the potential to strengthen the system: Public trust, compliance with food safety practices, and data sharing. Among the scenarios assessed, scenario 5, characterized by high levels of public trust, compliance, and data sharing, is determined as the optimal strategy.

Conclusions: By targeting these elements, countries can pave the way for more effective, sustainable, and culturally appropriate interventions that are critical for improving food safety and overall public health outcomes in these regions. Achieving Scenario 5 will require targeted investments in infrastructure, regulatory support, and public engagement. This study provides actionable insights for policymakers seeking to enhance FBD surveillance systems, contributing to stronger food safety and public health in Africa.