Ministry of Health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The mission of Food Safety in the Ministry of Health in Bahrain is to protect the health of the consumers from any health hazard through ensuring that food is safe and fit for human consumption whether imported from outside, prepared, or manufactured locally. In addition to maintaining a clean environment for the people in Bahrain as well as ensuring economic interests in food trade, this mission could be achieved through the vision to work jointly hand in hand with all segments of the society and involve them actively as far as possible in order to develop a food safety program that is the best in the region and a model that others follow in order to secure the highest levels of food safety. Food contamination can take place at any stage of food storage, processing and production. Biological, chemicals and physical contaminations are the major threat to food. Domestic Food Control Group monitors the safety of food available in local market via frequent routine visits for inspection based on daily scheduled duties as well as complaints from the public related to food. Main activities are conducted to elevate the safety level of displayed and presented food, and ensure that it is free from all types of contaminants, these activities include: 1. Routine inspection visits, 2. Withdrawing samples from public and private food establishments and including educational establishments, tourism, health centers, hospitals, and other establishments for laboratory examination to safeguard suitability for human consumption. 3. Educating and training food handlers and/or consumers via conducting symposiums, workshops, or preparing printable educational materials. Based on the Public Health Law No. 3 of 1975, authority was given the title of inspector commissioner to carry out inspections and issue notifications and warnings, fines, with closure notices for offenders with litigation before forwarded to the courts. In spite of the efforts done to improve food control and to ensure the fitness of food available in Bahrain; yet, all these efforts and practices are not sufficient to achieve the required results for a country free from prospects of food poisoning. For example, number of inspections was not enough and not directed to areas most susceptible to cause foodborne illness. In addition, there is no sound analysis and sufficient capacity to deal with food related complaints and restaurants administrative closure. Overall, there are challenges in the capacity to protect consumer from food borne illness, especially that Bahrain's population is showing tremendous growth (from 650,604 as per 2001 census, to 1,228,543 in 2010) (Source: MOH Website, Health Statistics) which reflects the increase in the need and consumption of food. Food entities reached 17,000 with only 33 domestic inspectors responsible for censorship, bearing in mind the fact that most of these entities employ expatriate food handlers who have little if any knowledge about food safety and most of them cannot communicate in either Arabic or English.

B. Strategic Approach

 2. What was the solution?
The “Consumer Protection from Foodborne Illnesses” started as a simple idea in 2011, shaped in 2012 and ripened in 2013.The idea was proposed by the Public Health Directorate Working Group, which was formed in the Competitiveness workshop as part of Bahrain Excellence Center training. The group analyzed the problem from the customer perspective, and focused on the importance of minimizing food borne illnesses and maximizing the safety of food available in local markets and restaurants. The initiative was about focusing on those restaurants most likely to cause food borne illnesses, visited by a larger number of people due to location (local popular areas), type of food served (fast or ready to eat food), and prices of food suitable for the majority of the population (medium to low prices). If we can make these restaurants serve safer food we would be protecting a bigger percentage of the targeted population. Therefore, Capital governorate was chosen for the pilot study and trial of the initiative as it recorded the highest numbers of food poisoning incidences, food related complaints, and newly licensed food entities. The strategy focused on increasing the availability and enriching the inspection procedure as it contained changing the “Penalizing Inspection “ to “Intelligent Inspection”, we started training few health inspectors to do more of quality inspections (educating, training, inspection, guidance and sampling). The main objective was to raise awareness and knowledge of food safety and reduce wrong practices among food handlers. The project considers food handlers as partners in consumer protection, as they are the link between authority & community. It works on strengthening their food safety knowledge and awareness to increase safety level of sold food, reduce violations & complaints, minimize food poisoning risk, and promote tourism & national economy. The initiative managed to reduce food poisoning incidences in the targeted areas, as per the statistical reports.

 3. How did the initiative solve the problem and improve people’s lives?
The initiative is creative and innovative as it used modest yet effective techniques to achieve its goals. Minor changes were made such as prioritizing the Inspectors tasks, making the inspection visits focused and targeted, computerizing and structuring the visits documentation to ease monitoring and follow up. All of this was achieved without extra manpower or resources. Moreover, the “Green Sticker” initiative which followed “Smart Inspection” focused on raising the transparency level, strengthening community partnership, and encouraging positive competitiveness. It was unique in looking at the problem from the customer point of view and start by changing our attitude towards it, instead of the easier regular solution by asking for more manpower and just increase the quantity while ignoring the quality of work done.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
• 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.
 6. How was the strategy implemented and what resources were mobilized?
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).

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
It is widely known that food comprises an essential component of our lives; the current busy and rapid lifestyle led more people to consume more and more ready meals as a measure of saving time. These facts are reflected by the increasing numbers of food businesses not only in Bahrain, but in the whole world. Bahrain is a small country in size (767.26 Square Kilometers) and population (1,195,020) (Source: eGovernment portal), but it is big in business and economy. In 2010, around 17000 food entities were registered in Bahrain, however, in 2011 alone 1954 new licensed transaction were made by the Public Health Licensing Unit, and this increased to 2540 transactions in 2012. According to the Household Income & Expenditure Survey in 2005-2006, 21.2% of the total Bahraini household expenditure was spent on food, beverages and tobacco items. A strong measure to minimize the risk of food borne illnesses is becoming more important now than it ever was. This initiative managed to decrease the incidence of food poisoning which will be reflected on the consumers trust in the Food Control system, and in the food processing industry. This will hopefully affect the overall economy and tourism in the country. The food control service was being delivered by force and rigidity which was reflected in the actions of the inspectors entering any food premises phishing for mistakes and violations, proud to issue more violation notices and fines. This led the business managers and food handlers to clear the premises and hide risk materials only in the presence of the inspector. After applying the intelligent inspection, inspectors managed to gain the trust of managers and food handlers that we are here to help and protect your business from any probable risks which might cause food poisoning and have irreversible effects on the overall business. We assured them that we work side by side to protect their work and the consumers for everyone’s good. Now whenever an inspector enters the food premises, he/she is greeted by the staff, having some queries for him/her or seeking a new advice. A new sticker (the Hotline sticker) was placed in the front window of many food premises to involve the public and assure them of our availability and trust in the food premises. Even though complaints increased in the beginning, it reflects the cooperation of the businesses and the public with the authority, and we look at it as an opportunity to strengthen food safety.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Sustainability of the initiative: Financial: as mentioned above, this initiative does not require any additional financial cost as it is done by the current staff during the same working hours. Social: this initiative has accomplished enhanced the authority relation with both the food managers/handlers and the end customers, this relation encourages the inspectors to work with more satisfaction. Economic: the continuity of the initiative was shown to have good results and benefits for all sides who are working together to sustain it for better business. Cultural: as the initiative encouraged the public to reach for us and contact the authority in case of complain, they will continue to do so as this satisfies the customers. Regulatory: the close and continuous follow up by the higher authority in the Ministry of Health, asking for reports, meetings, briefings future plans and presentations on the updates keeps the work team alert as it has for the past 28 months.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Many simple nonetheless important lessons were learned along the way, including but not limited to: 1- Small yet sustainable changes can achieve big results over time. We started working on our availability only, but this affected the quality of work done and made us more eager to make bigger changes. 2- Collaboration and cooperation with other sectors (food businesses, laboratory, disease control . . . ) aids in achieving better results and more satisfaction. Simple techniques learned from laboratory staff reduced the number of rejected samples and increased the accuracy of the results. Working closely with the communicable disease unit made us understand the extent of food poisoning in the country and its effect on the people as we used to look at the number of restaurants causing illnesses, but now we look at the number of people affected by this and the severity of this food borne illness. 3- When we start changing the way we do things and look at them we manage to make better progress. Starting with ourselves makes changes easier and made food managers/handlers more cooperative and wanting to work hand in hand with us.

Contact Information

Institution Name:   Ministry of Health
Institution Type:   Government Agency  
Contact Person:   Manal AlSairafi
Title:   Coordinator  
Telephone/ Fax:  
Institution's / Project's Website:  
E-mail:   msairafi@health.gov.bh  
Address:  
Postal Code:  
City:   Manama
State/Province:  
Country:  

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