| 4. In which ways is the initiative creative and innovative?
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As the target was those restaurants more vulnerable to cause food borne diseases, the action plan developed to implement the strategy was as follows:
Start with the “Capital Governorate” as a pilot study and trial of the initiative due to three facts:
1- During the past year, the capital governorate recorded the highest number of food poisoning incidences,
2- It recorded the highest number of food related complaints from the public community,
3- And it has the largest number of newly licensed food entities.
Three inspectors were trained to conduct the pilot study, we measured the time required to cover all components of the visit to make it comprehensive (training, educating, guidance, inspection and sampling). The best plan time wise was to spend at least 60 minutes in each restaurant, covering 4 restaurants per day.
Translated educational materials were downloaded from the World Health Organization (WHO) site, bind, and presented to the food handlers to facilitate communication.
Laboratory staff gave short training sessions to the assigned inspectors on how to withdraw samples, and manage the transportation in special containers.
As the documentation was computerized, we managed to follow up the total visits level, numbers and locations of participating restaurants (in case of complaints or poisoning).
The initiative focused on changing the way of thinking (Mind Set), so we wanted to guide the food handlers not go phishing their mistakes and look for violations, as they are now treated as our partners in protection.
The plan was to start the pilot study by April/May 2012, look at initial results and make necessary changes for a better plan to be considered for gradual generalization from December 2012 to mid-2013.
The original plan was modified along the way based on outcomes and measured progress, yet, the generalization was attained by June 2013 after achieving concrete results.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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• The planning and mind storming stage:
At this stage, the team comprised of the “Public Health Excellence Team” (Public Health Director, Excellence coordinator, Chief of Public Health Laboratory, Chief of Food Control Section) alongside Bahrain Excellence Center Expert,
• The implementation stage:
At this stage, Food Hygiene Specialists (Supervisors) and Public Health Specialists (Inspectors) joined and were trained as they form the first and second line involved in the application of the initiative.
Also, public health laboratory staff joined to facilitate and manage the sampling procedures.
From the food businesses, managers and / or supervisors of the participating restaurants also joined to be prepared for the upcoming change and to act as real partners in consumer protection. As time passed many food handlers were joining the team as they are the main and direct personnel involved in the safety of food provided at the participating restaurants.
Members of the community were involved by taking part in the related surveys.
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| 6. How was the strategy implemented and what resources were mobilized?
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This is the main innovative point about the initiative; the implementation focused on amending the main tasks of the inspector besides teaching him/her some time management techniques to organize the work.
Therefore, it was literally implemented according to existing resources without any additional financial or human resources or manpower. However, technical guidance on sampling procedures was provided by the lab staff without any additional cost (Samples are taken from the food premises, from the working staff mainly food handlers, and from the food stuff stored, prepared or ready to be served).
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The main outputs of the initiative were:
1. Reduction of food poisoning incidence in the targeted restaurants during the period in which the initiative was applied as compared with the previous period.
2. Ease of follow up as the main inspection work documentation is available in a computerized, well-structured form.
3. Change in the attitude of the Inspectors which made them friendlier, yet focused on their duty. This led to positive and encouraging relation between the inspectors and food handlers / restaurant managers.
4. Interrelations between various public health sections related to food poisoning were strengthened due to the implementation (food control, laboratory, communicable disease control).
5. Evolvement of “Green Sticker” project from the main initiative.
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| 8. What were the most successful outputs and why was the initiative effective?
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Monitoring and evaluation involved several measures including:
1- Using a simple Excel sheet designed specifically to follow-up the daily work according to the region visited, inspector carrying out the inspection, date, and number of restaurants visited.
2- Collaboration with the disease control to match food poisoning statistics according to regions, individuals, and restaurants. Cooperation of laboratory staff to speed up the required analysis, and train inspectors on the best ways to withdraw and transfer the samples.
3- The systematic follow-up of the “Excellence Strategic Team” in the Ministry of Health led by Her Excellency the Undersecretary along with Her Excellency the Assistant Undersecretary for Primary Care and Public Health.
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| 9. What were the main obstacles encountered and how were they overcome?
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The main encountered obstacles:
1. The language barrier between inspectors and food handlers:
Most of the food handlers were Asians or non-Arabic-speaking, understanding
their native language only, while the inspectors were capable of communicating
in either Arabic or English Language only, with few of them able to
communicate in Urdu.
To overcome this obstacle: We printed the basic food safety guidelines from the World Health Organization site in several languages (Malay, Bengali, Turkmen, Urdu, Persian, Pilipino, Indonesian and Thai) as these are the main languages spoken by the food handlers. These were distributed to facilitate communication.
Also, we translated some local requirements into Urdu, and prepared some illustrated guiding material.
2. Inspectors’ Tasks:
The inspectors were involved in many tasks besides the inspection visits, which reduced the ability to control, train, and educate food handlers during the limited visit duration.
To overcome this obstacle: Tasks were coordinated with supervisors to allow inspectors to spend more time per restaurant and conduct the inspection comprehensively.
3. Documentation:
With manual and non-regular documentation of daily work it was difficult to extract information whenever needed, and it was more difficult to follow up as it requires considerable effort and time.
To overcome this obstacle: we designed a simplified electronic Excel sheet which enabled us to generate reports on a weekly basis.
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