Food Safety Legislation, Standards, and Measures in Ethiopia: A Scoping Review

Abstract

Background:

Low-income countries such as Ethiopia face significant food safety challenges due to weak regulatory enforcement, limited infrastructure, and rapid urbanization. In addition, the rising incidence of foodborne illnesses and emerging bioterrorism threats underscore the urgent need for robust legislation, effective regulation, and coordinated food safety measures.

Objectives:

This review aimed to assess the food safety regulatory framework, standards implementation, and on-the-ground practices in the context of Ethiopia.

Methods:

This scoping review included peer-reviewed articles and gray literature, such as institutional reports and unpublished documents. Data were retrieved from Google Scholar, Scopus, PubMed, and relevant organizational websites. The review was conducted in accordance with the PRISMA-ScR 2020 checklist, with document selection guided by the SPIDER framework.

Results:

Ethiopia has adopted a multi-agency food safety governance model involving several sectoral institutions, notably the Ethiopian Food and Drug Authority and the Ministries of Health, Trade and Industry, and Agriculture. Despite this institutional architecture, implementation is constrained by weak enforcement, poor intersectoral coordination, limited adoption of internationally recognized food safety certification systems, and inadequate foodborne disease surveillance, resulting in persistent deficiencies in food safety and handling practices across the food supply chain.

Conclusion:

Despite the presence of food and nutrition policies, food safety regulations, standards, and a formal regulatory framework, this scoping review, among the first to comprehensively map Ethiopia’s food safety governance, identifies a substantial gap between policy design and practical implementation. Although government and non-governmental organizations have provided training on good hygiene practices, good manufacturing practices, and hazard analysis and critical control points, these efforts have not produced sustained improvements due to weak enforcement, fragmented institutional coordination, and limited surveillance capacity. The findings underscore the need to shift from policy development to implementation-focused reforms, strengthened accountability, and integrated regulatory action to improve food safety outcomes in Ethiopia and similar low-income settings.

Introduction

Food safety laws are legally enacted frameworks that govern the production, processing, transportation, distribution, and sale of food products. They establish the overarching legal authority for food safety oversight, including provisions related to hygiene, labeling, enforcement mechanisms, and the adoption of standards. ¹ Food safety regulations are legally binding rules issued under these laws to operationalize food safety requirements. They specify enforceable obligations for food system actors, impose behavioral controls on suppliers, and define penalties for noncompliance, thereby ensuring food safety, quality, and hygiene. ² Collectively, these regulations aim to protect consumers from unsafe or fraudulent food products by addressing issues such as food additives, weights and measures, hygiene practices, pesticide use, veterinary drug residues, advertising, packaging, and labeling. ³

Food safety standards consist of technical requirements and guidelines developed to ensure that food products are safe for human consumption. They focus on preventing, controlling, and minimizing contamination risks and apply across all stages of the food supply chain, from production to consumption.^4,5 Globally, countries employ different organizational models in their food safety systems, which include integrated, multi-agency, and single-authority. The single-authority model is where 1 organization handles all aspects of food safety responsibilities; the multi-agency model is where responsibilities are shared between different organizations; and the integrated model is where responsibilities are shared based on sectoral functions but coordinated over a common goal.^6,7

Each model has advantages and drawbacks; for example, the multi-agency approach may suffer from duplication of efforts and poor coordination between organizations. Nonetheless, clear legislation is crucial in guiding these systems and addressing modern food safety challenges, such as the overuse of antibiotics in animal production, bioterrorism, and the impacts of urbanization, particularly in low- and middle-income countries.^6,8 Expanding upon statutory provisions, food safety regulations provide the operational rules and standards that food enterprises and regulatory bodies must adhere to for compliance, including hygiene and sanitation standards and practices, good manufacturing practices, restrictions on pesticide and veterinary drug residues, and mandates for hazard analysis and traceability systems.^7,9,10 Food safety standards have had to develop in response to the increasing complexity of food systems as a result of globalization, technological advancements, and more international trade practices.^11,12 In high-income countries, strict regulatory enforcement has helped reduce foodborne disease loads to around 23 million illnesses and 5000 fatalities each year.^10,13 In contrast, poor countries continue to face substantial obstacles, with an estimated 91 million illnesses and 137 000 deaths in Africa each year. ¹³ Weak enforcement is further exacerbated by inadequate institutional coordination, limited food safety infrastructure, insufficient investment in contemporary technologies, and low levels of training and awareness among food handlers.^{13 -15}

In addition to legislation and regulations, food safety measures refer to the practical actions and control practices implemented throughout the food supply chain to achieve compliance with food safety laws, regulations, and standards. These include safe food handling, personal hygiene, cleaning and sanitation (including pest control and disinfection), food testing and monitoring, temperature control, supply chain communication, and the application of internationally recognized systems such as Hazard Analysis and Critical Control Points (HACCP), Good Manufacturing Practices (GMP), and Good Hygiene Practices (GHP).^10,16,17 These practices are intended to ensure food safety from farm to fork. The growing use of antibiotics in large-scale agriculture, changing animal breeding techniques, and technical advancements in food processing, preservation, and packaging all pose new food safety issues.^8,11,18 Furthermore, vulnerable populations such as children, the elderly, pregnant women, and immunocompromised people are more susceptible to foodborne infections. ¹⁹ Many low- and middle-income countries, including Ethiopia, have experienced repeated outbreaks due to urbanization and weak enforcement of food safety regulations and measures. ⁸ As a result, prioritizing food safety implementation at all stages of the supply chain is critical.

Ethiopia has made substantial progress in implementing food safety measures, including the adoption of policies, training initiatives, and institutional responsibilities. ²⁰ Still, major hurdles remain in implementation and enforcement. The Ethiopian Food and Drug Authority (EFDA), the Ministry of Health, the Ministry of Trade and Industry, and the Ministry of Agriculture are all expected to work together to ensure food safety practices in the country. ²⁰ Despite this structure, deficiencies in collaboration, coordination, inadequate infrastructure, and insufficient surveillance systems of food borne disease impede efficient food safety management. ²⁰ Contaminated food continues to be a leading source of foodborne illness, particularly associated with the ingestion of raw meat and milk.^21,22 Foodborne pathogens such as Salmonella, Listeria monocytogenes, Escherichia coli, Campylobacter spp., and Shigella have been repeatedly identified in Ethiopian studies in both endemic and epidemic ways. ²³

Ethiopia has established food safety laws, standards, and institutional mandates involving multiple regulatory bodies across the food supply chain. However, evidence remains fragmented regarding implementation, enforcement capacity, intersectoral coordination, and the translation of regulations into practice, with notable gaps in surveillance systems and enforcement consistency. This scoping review maps and synthesizes existing evidence on the availability, implementation, and enforcement of food safety regulations, standards, and measures in Ethiopia, with the aim of identifying gaps and informing policy options and future research.

Addressing these gaps requires a coordinated approach that combines strong legislation, effective regulatory enforcement, and widespread implementation of safety measures across the food supply chain. Accordingly, the review assesses the status of Ethiopia’s food safety regulatory framework, including the availability of legislation and standards, their implementation, and on-the-ground practices.

Methods

This study employed a scoping review design to map and synthesize available evidence on food safety legislation, regulations, standards, and enforcement measures in Ethiopia. A scoping review was considered appropriate given the diverse, fragmented, and heterogeneous nature of the evidence, which includes empirical studies, policy documents, legal instruments, and institutional reports. The review followed the PRISMA-ScR 2020 checklist to systematically identify, select, extract, and summarize relevant evidence up to August 20, 2024. This approach allowed comprehensive mapping of knowledge, identification of gaps, and clarification of key concepts to inform policy options and future research areas. Accordingly, formal quality appraisal was intentionally omitted, consistent with the methodological purpose of scoping reviews as well as the methodological limitations of institutional reports.

A scoping review allows comprehensive mapping of existing evidence, identification of gaps, and clarification of key concepts to inform future research and policy on food safety legislation, regulations, standards, and measures. In this review, published articles and gray literature, including institutional reports and unpublished research findings, with a focus on Ethiopia’s food safety legislation, regulations, and measures, were included. The review process was guided by using the PRISMA-ScR Checklist 2020 method without restricting the publication period of included articles until August 20, 2024. This framework helps us to map knowledge research topic formulations, identify pertinent studies, collect data (papers), organize and summarize, and report the results.

Search Strategy

This scoping review was conducted and reported in accordance with the PRISMA-ScR 2020 guidelines. A systematic and reproducible search strategy was applied to identify relevant peer-reviewed and gray literature. Electronic searches were conducted in PubMed, Scopus, and Google Scholar, complemented by targeted searches of governmental and non-governmental organization websites. The search strategy combined free-text keywords and controlled vocabulary (MeSH terms) using Boolean operators (AND, OR). Search terms included “food safety,” “food safety measures,” “food safety standards,” “food safety regulations,” “food laws,” “foodborne disease,” “food safety management system,” “food hygiene standards,” “food hygiene practice,” “food handlers,” “food industries,” “food contamination,” “food safety hazards,” and “Ethiopia.” For transparency and reproducibility, the detailed database-specific search strings are presented in Supplementary Table 1.

In addition, reference and citation tracking (snowballing) was used to identify relevant articles from the reference lists and citations of retrieved documents. Phone calls and in-person consultations with governmental officers were conducted to access regulations and standards not available on online platforms. Two independent reviewers screened all documents against the eligibility criteria, and any disagreements were resolved through discussion. All retrieved references were imported into EndNote for duplicate removal before title and abstract screening. The detailed retrieved documents included in the review are presented in Supplementary Table 2.

The restriction to English-language documents may have resulted in the exclusion of relevant policy documents, guidelines, or regulatory materials available only in Amharic, thereby limiting the comprehensiveness of the review. The overall process of accessing and selecting pertinent articles and institutional documents is presented as follows (Figure 1).

Figure 1.

Overall process of selecting pertinent articles and institutional documents.

Eligibility Criteria

After identifying and retrieving all relevant articles and documents from Google Scholar, Scopus, and PubMed databases, as well as from government and non-governmental organization websites, the records were exported to EndNote software for reference management and removal of duplicates. The screening process was conducted in 2 stages: first, titles and abstracts were reviewed to identify potentially relevant documents; second, full-text articles were independently assessed by both authors to confirm eligibility based on predefined inclusion criteria and the presence of relevant outcomes related to food safety legislation, regulation, and implementation measures in Ethiopia.

To enhance transparency and methodological rigor, the selection and reporting process was guided by the PRISMA-ScR 2020 checklist, while the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation, Research type) was applied to systematically define eligibility criteria, reflecting the policy- and implementation-oriented focus of the review. This approach ensured comprehensive inclusion of diverse stakeholders, study designs, and evidence types relevant to food safety governance and implementation. The detailed inclusion and exclusion criteria derived from the SPIDER framework are presented in Tables 1 and 2.

Table 1.

Eligibility (Inclusion and Exclusion) Criteria for the Scoping Review on Food Safety Legislation, Regulation, Standards, and Measures in Ethiopia.

SPIDER element	Inclusion criteria	Exclusion criteria
S – sample/population	Government and regulatory bodies; agriculture and food production sectors; food vendors and retailers; consumers; health and education sectors; non-governmental organizations; academic institutions; international agencies involved in food safety	Populations or sectors not related to food safety governance, regulation, standards, or implementation
PI – phenomenon of interest	Implementation of food safety legislation, regulations, standards, and measures in Ethiopia	Studies not addressing food safety governance or implementation
D – design	Qualitative, quantitative, and mixed-methods studies, as well as policy documents, legislative and regulatory texts, standards, guidelines, strategies, reports, and official web-based documents addressing food safety implementation	Documents not addressing food safety legislation, regulation, standards, or their implementation
E – evaluation/outcomes	Evidence on the availability, implementation, and enforcement of food safety regulations, standards, and measures	Studies lacking outcomes related to food safety implementation
R – research type/publication	Peer-reviewed articles, theses, and reports from governmental or non-governmental organizations; full-text in English; published up to August 2024	Editorials, commentaries, opinion pieces, inaccessible full-texts, non-English publications, or publications after August 2024

Table 2.

Classification of Included References by Source Type in the Scoping Review of Food Safety Legislation, Regulations, Standards, and Measures.

Category	Description	Number of sources (n)	Percentage (%)
Peer-reviewed journal articles	Published in journals	57	67.9
Institutional/organizational reports	WHO, FAO, EFDA, World Bank	12	14.3
Legal documents and directives	Proclamations, regulations	9	10.7
Standards and guidelines	Codex, ISO, national standards	6	7.1
Total		84	100

Results

The search strategy initially identified 1290 records, including 1225 records from Scopus, Google Scholar, and PubMed, and 65 records from governmental and non-governmental organization websites, all broadly relevant to food safety legislation, regulations, guidelines, and measures. After removing 590 duplicates using EndNote, 635 records underwent title and abstract screening, resulting in 344 exclusions. Full-text assessment of the remaining 291 records led to the exclusion of 234 articles due to inaccessibility, insufficient relevance, or failure to meet eligibility criteria. From organizational sources, 38 of the 65 records were excluded for similar reasons. In total, 84 sources of evidence documents were included in the scoping review, comprising 57 peer-reviewed journal articles and 27 organizational, legal, and standards-related documents (Supplementary Table 2). Thematic analysis of the included literature indicates that a substantial proportion focuses on food safety regulations (33 sources), emphasizing legislative frameworks, enforcement capacity, and institutional roles. Fewer sources address food safety standards implementation (8 sources), highlighting gaps in compliance, monitoring, and harmonization with Codex and other international benchmarks. Most studies examine practical food safety measures (39 sources), particularly food hygiene and handling practices, revealing wide variability in adherence across different nodes of the food supply chain. Only a small number of sources (3 sources) explicitly explore the intersection between regulations and standards, and only 1 source addresses regulations, standards, and practical measures simultaneously, indicating a marked lack of integrated food safety system assessments. The detailed retrieved documents included in the review are presented in Supplementary Table 2. Overall, the literature demonstrates fragmented evidence and persistent gaps linking regulatory frameworks, standards, and on-the-ground level practices in Ethiopia (Figure 2).

Figure 2.

PRISIMA 2020 flow diagram of the selection process of published articles, reports, and unpublished articles (gray literature) for review.

Discussion

Food Safety Regulations

Ethiopia’s food safety governance is characterized by a multi-agency regulatory system in which mandates are distributed across the Ethiopian Food and Drug Authority (EFDA), Ministry of Health (MoH), Ministry of Agriculture (MoA), Ministry of Trade and Industry (MoTI), and their respective regional and local counterparts.^6,7,24,25 This fragmented institutional architecture has deep historical roots. Early regulatory developments, including the 1947 public health decree, the establishment of a national standards organization in 1970, plant quarantine regulations, and successive animal disease control proclamations, demonstrate Ethiopia’s long-standing recognition of public health protection, agricultural biosecurity, and standardization.^{26 -30} However, these historical milestones were largely sector-specific and narrowly focused and were not designed to address contemporary, integrated food safety challenges across complex value chains.^{26 -30} Their legacy is reflected in the present government structure, where food safety responsibilities evolved in institutional silos rather than through a unified, system-wide framework.^{27,31 -35} More recent regulatory reforms, particularly the establishment of the former Food, Medicine, Health Care Administration, and Control Authority (FMHACA) in 2010 and its transformation into the Ethiopian Food and Drug Authority (EFDA) under Proclamation No 1112/2019, represent important institutional progress toward consolidating food safety oversight.^{36 -38} EFDA now holds a clear legal mandate to regulate food alongside medicines, tobacco, cosmetics, and medical devices. Nevertheless, the existence of legal mandates has not translated into effective implementation. In practice, enforcement remains weak due to overlapping institutional responsibilities, conflicts of interest and role mix-ups, limited coordination mechanisms, constrained inspection authority, and inadequate laboratory and surveillance capacity.^{26 -30} EFDA regulations largely exclude informal markets, street food vendors, and mass catering establishments, which dominate food distribution and consumption in Ethiopia and where poor food handling practices are prevalent. ³⁶ Packaging regulations are also selectively applied, covering primarily trans-regional products while leaving locally distributed foods weakly regulated.^{36,39 -41} Although directives are critical for operationalizing laws, EFDA has issued only a limited number of food-related directives, resulting in uneven implementation and leaving major areas of food safety insufficiently regulated.^{39,40,42 -44} Similar fragmentation is evident within the agricultural sector, where multiple proclamations govern meat inspection, plant quarantine, veterinary drugs, animal feed, and pesticides.^28,45,46 Many of these laws are outdated, narrowly scoped, or poorly aligned with current food safety risks. For example, the Meat Inspection Proclamation No 81/1976 prioritizes export-oriented and formal slaughter systems, excludes informal markets, and overlaps with EFDA mandates for processed meat products, thereby weakening domestic food safety oversight. ³⁶ Likewise, the Plant Quarantine Regulation focuses primarily on plant health and disease prevention, neglecting broader food safety risks associated with post-harvest handling, storage, and market conditions. ²⁸ Although pesticide registration and regulatory frameworks have advanced over the past 3 decades, weak enforcement, limited monitoring capacity, and poor inter-sectoral coordination have resulted in extensive pesticide residue contamination in food, soil, and water, posing risks to human health and the environment.^{46 -53} Empirical evidence of pesticide residues exceeding international limits in staple crops and vegetables highlights a persistent gap between regulatory intent and practice.^{48 -50} These enforcement failures are exacerbated by inadequate inspection systems, limited laboratory capacity, ineffective law enforcement, and low awareness among farmers, further undermining food safety outcomes.^52,53 While this institutional architecture exists legally, practical enforcement remains weak, largely due to overlapping mandates, limited collaboration and coordination mechanisms, and constrained enforcement capacity.^{31 -35} Comparable multi-agency arrangements are observed in other low-income and African contexts, including Kenya, Ghana, Tanzania, and Nigeria, where food safety responsibilities are similarly fragmented across health, agriculture, trade, and standards authorities.^{54 -58} However, cross-country comparisons suggest that Ethiopia exhibits more pronounced enforcement gaps than some peers, particularly in inspection coverage, routine residue monitoring, laboratory infrastructure, and accountability mechanisms.^55,59 Kenya and Ghana have made progress in establishing central coordination units or lead authorities to facilitate inter-sectoral collaboration, especially in export-oriented food chains. In contrast, Ethiopia lacks a single empowered body with authority over the entire food chain, particularly in informal markets and mass catering settings.^56,57 Although a national food and nutrition policy and several sector-specific proclamations exist, implementation has lagged, primarily due to the absence of harmonized guidelines, limited institutional authority, and weak inter-agency coordination.^{60 -62} The policy itself provides little guidance on establishing an autonomous coordinating body, and the country still lacks a unified federal food safety law, further constraining enforcement capacity. ³⁸ This disconnect between law on paper and law in practice is consistently documented in the literature and mirrors findings from other low-income settings, where enforcement capacity, rather than legal scarcity, is the dominant constraint.^27,61

This disconnection between law on paper and law in practice is a recurring theme across the literature and aligns with findings from other low-income settings, where enforcement capacity, rather than legal scarcity, is the dominant constraint.^27,55,58,61 The consequences of fragmented governance and weak enforcement are evident in poor food safety practices across both formal and informal settings, including food establishments, abattoirs, street vending, and household food handling.^{63 -85} Inspection activities are inconsistent, risk-based approaches are rarely applied, and compliance monitoring is divided across institutions with overlapping mandates. Similar associations between weak enforcement and poor food safety practices have been reported in Nigeria and Tanzania, reinforcing the conclusion that institutional effectiveness, rather than the mere presence of policies or laws, is the critical determinant of food safety outcomes.^58,59,86 Overall, comparative evidence suggests that Ethiopia’s food safety challenges are structural rather than exceptional; however, the country has missed opportunities to adopt coordination and enforcement models that have demonstrated relative effectiveness in comparable African contexts.^58,59,86 Addressing these gaps will require moving beyond regulatory proliferation toward institutional consolidation, enforcement accountability, and empirical evaluation of regulatory performance, particularly within informal markets and mass catering sectors where the majority of food consumption occurs.

Food Safety Standards

Food safety standards play a critical role in protecting consumers’ health and facilitating fair and transparent international food trade, complementing regulatory controls and reducing the risk of foodborne diseases. ⁸⁷ These standards encompass comprehensive systems such as Hazard Analysis and Critical Control Points (HACCP), Good Manufacturing Practices (GMP), Food Safety Management Systems (FSMS), supplier control, allergen management, traceability, employee training, and quality assurance, alongside core food hygiene requirements including personal hygiene, sanitation, temperature control, pest management, and facility maintenance.^{7,88 -90} In Ethiopia, as in many low-income countries, the predominance of voluntary food safety standards limits effective compliance in informal and domestic markets, where enforcement mechanisms are weak, and adoption depends largely on market incentives rather than legal obligation.^89,91 Informal food actors – who supply a substantial proportion of domestically consumed food often lack the financial, technical, and institutional capacity to implement voluntary standards, resulting in uneven compliance and persistent food safety risks. ⁸⁹ Institutionally, Ethiopia’s standardization system, now led by the Ethiopian Standards Institute (ESI), has developed more than 7000 national standards, including ~850 related to food safety and hygiene.^30,92,93 While some health-related parameters, such as selected pesticide maximum residue limits, are mandatory, many food safety standards remain voluntary, and several critical statutory standards (eg, for food additives, spices, and mycotoxin limits) are absent or inadequately addressed.^33,94 This limits Ethiopia’s alignment with Codex Alimentarius standards, which serve as the international benchmark for food safety and underpin the World Trade Organization’s Sanitary and Phytosanitary (SPS) Agreement.^87,90 Insufficient harmonization with Codex standards not only weakens domestic consumer protection but also constrains Ethiopia’s participation in international food trade by increasing the risk of export rejection and reducing competitiveness in global markets.^90,95 The effectiveness of food safety standards in Ethiopia is further constrained by inadequate funding, limited laboratory capacity, and weak inter-agency coordination between standard-setting bodies and regulatory authorities.^60,88 These systemic constraints disproportionately affect informal markets, where inspection and enforcement are minimal, contributing to the continued burden of foodborne diseases.^23,88,89 Strengthening the transition from voluntary to risk-based mandatory standards in high-risk food chains, improving Codex alignment, and enhancing institutional coordination are therefore critical to improving compliance and country-owned standards across both domestic and export markets and ensuring meaningful public health protection.^88,95

Food Safety Measures/Procedures

Food safety procedures are essential for protecting public health, preventing foodborne diseases, and maintaining the integrity of the food sector across the supply chain.^17,90 These procedures encompass a broad range of practices, including personal hygiene, GMP, FSMS, HACCP, traceability and recall mechanisms, inspection, temperature control, sanitation, pest control, water quality management, facility design and maintenance, staff training, and regulatory compliance.^10,17,89

Personal hygiene and food handling practices emerge as consistently weak areas across food sectors. Numerous studies report inadequate handwashing, improper use of protective clothing, unsafe food handling, and poor adherence to cooking and storage temperature requirements among food handlers.^10,17,89 Although Ethiopia introduced food hygiene and drinking water standards in 2021, compliance remains low, particularly in informal and small-scale food establishments.^10,17,89,96 These shortcomings reflect limited enforcement capacity and weak translation of standards into routine practice.

Training and knowledge gaps are another dominant theme. Despite training efforts by government and non-governmental organizations on GHP, GMP, and HACCP, food handlers’ practices remain suboptimal.^60,97 Across food and drinking establishments, more than three-quarters of reviewed studies reported that at least half of food handlers demonstrated poor food safety practices, while the remaining studies still documented substantial noncompliance.^{63 -65,67,69,70,73,84,85,98} Similar deficiencies were observed among meat handlers in butcher shops and abattoirs, where most studies reported inadequate practices and poor compliance with inspection protocols.^{71,72,75,77,99 -101} These findings indicate that training programs are often insufficiently institutionalized, inconsistently delivered, or disconnected from enforcement mechanisms.

Infrastructure and sanitary conditions also play a critical role. Studies consistently documented poor sanitary environments in food and beverage establishments, including inadequate water supply, poor waste management, lack of proper sanitation facilities, and high levels of microbial contamination.^{63 -65,69,70,73,84,85,98} Such infrastructural deficiencies undermine the effective implementation of hygiene standards and are closely linked to gaps in regulatory oversight and resource allocation.

Inspection, monitoring, and enforcement weaknesses further exacerbate poor practices. Street food vendors, who supply a substantial share of urban food consumption, were repeatedly reported to exhibit unsafe food handling and hygiene practices, with two-thirds of studies indicating that more than three-quarters of vendors performed poorly.^{74,76,83,102,103} Similarly, community- and household-level studies revealed that at least half of food handlers demonstrated inadequate food safety and hygiene practices.^{78,82,104 -107} These patterns are closely associated with limited inspection coverage, particularly in informal markets that fall outside routine regulatory supervision. Summary of key determinants: Across settings, the most consistent determinants of poor food safety practice include inadequate personal hygiene, insufficient and poorly sustained training, weak inspection and enforcement systems, inadequate infrastructure (especially water and sanitation), and limited awareness of food safety standards. Importantly, these determinants are not isolated behavioral failures but are systematically linked to earlier-identified regulatory and standards gaps, including reliance on voluntary standards, fragmented institutional responsibilities, weak enforcement authority, and exclusion of informal food sectors from effective regulatory oversight.^{27,31 -35,58,59}

As a consequence, foodborne disease outbreaks in Ethiopia are frequently associated with contaminated food and unsafe drinking water,^21,22,108 affecting an estimated 5 million people annually and resulting in ~3300 deaths and 255 000 lost healthy life years, with a disproportionate burden among children under 5 years of age. ¹⁰⁹ Collectively, these findings underscore the urgent need to strengthen regulatory enforcement, align standards with on-the-ground realities, expand inspection coverage to informal markets, and institutionalize continuous, enforceable food handler training across the entire food supply chain.

Conclusions and Recommendations

Despite sustained efforts by the Ethiopian government and non-governmental organizations to expand training in GHP, GMP, and HACCP, and to establish food safety policies, regulations, standards, and regulatory institutions, significant gaps persist in implementation, enforcement, and coordination, particularly in informal markets, small-scale food establishments, and pesticide-intensive agricultural settings. Many existing food safety regulations, standards, and directives remain outdated and insufficiently adapted to current food systems, while fragmented institutional mandates and limited enforcement authority constrain effective oversight. These weaknesses are most evident in food handling environments such as street food vending, butcheries, abattoirs, and household food preparation – where empirical evidence consistently shows that more than half of food handlers fail to meet basic food safety and hygiene requirements. In the agricultural sector, rapidly increasing pesticide use, coupled with weak monitoring and residue enforcement, further amplifies food safety risks.

In the short term, policy efforts should prioritize strengthening inspection and enforcement capacity in high-risk and underserved settings, particularly informal food markets and small food businesses, through targeted inspections, simplified compliance tools, and routine monitoring of hygiene practices and pesticide residues. In the medium term, Ethiopia should update and harmonize existing food safety regulations and standards, transition selected high-risk voluntary standards into mandatory, risk-based requirements, and establish a formal inter-agency coordination mechanism to reduce overlapping mandates and enforcement gaps. In the long term, the enactment of a comprehensive federal food safety law aligned with Codex Alimentarius standards is essential to clarify institutional responsibilities, strengthen accountability, and enhance both domestic consumer protection and international trade competitiveness.

Future research should move beyond descriptive assessments of food safety practices to empirically evaluate the effectiveness of enforcement mechanisms, including inspection frequency, penalty structures, incentive-based compliance, and institutional coordination models. Rigorous evaluations of how regulatory enforcement influences food handler behavior, particularly in informal and domestic food systems, are critical to informing evidence-based reforms and strengthening Ethiopia’s food safety governance.