INVESTIGATING RIYADH’S PUBLIC HEALTH INSPECTORS' ABILITY TO CONDUCT RISK-BASED FOOD INSPECTION, AND THEIR PROFESSIONAL NEEDS A Mixed-Methods Research Study Sultan Abdullah Alsaleh BPubHlth-HP, MPH Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health and Social Work Faculty of Health Queensland University of Technology 2021 ﷲ ا ا In the name of Allah, the Most Gracious, the Most Merciful Page | ii Keywords Environmental Health Officer (EHO), food safety, Food and Agriculture Organization (FAO), foodborne illness (FBI), Hazard Analysis and Critical Control Point (HACCP), Knowledge-to- action framework (KTA), Ministry of Municipal and Rural Affairs, Public Health Inspector (PHI), risk-based food inspection, Saudi Arabia, traditional food inspection. Page | iii Abstract Background Every year about 600 million –—almost 1 in 10 people in the world –—fall ill after eating unsafe food, and more than 400,000 people die. Public Health Inspectors (PHIs) perform important roles and have numerous responsibilities in efficiently protecting public health from foodborne illnesses (FBIs). Some of these roles and responsibilities include undertaking food safety assessments, enforcing local food safety legislation, and providing support to food establishments (i.e., restaurants) regarding the minimization of food safety risks. The processes of qualifying and training PHIs, and ensuring timely addressing of their professional needs are essential for the successful and safe development of the food industry in any country. At the same time, there is a significant knowledge gap in the food safety area in the Gulf Cooperation Council (GCC) countries, including Saudi Arabia, which is related to the lack of a detailed understanding of the major issues preventing, or interfering with, the implementation and improvement of a food safety inspection approach. Purpose There are two key approaches towards food safety inspection at the food establishments across the globe —the traditional approach and the risk-based (modern) approach. The traditional approach typically focuses on reactive measures towards problems once they have been identified. In contrast, the risk-based approach recommended for adoption by the Food and Agriculture Organization of the United Nations (FAO) has a more proactive character, whereby it attempts to identify and address food safety issues before they actually become a public threat. The transition of Saudi Arabia to the risk-based food safety approach raises important questions about the professional needs of the Saudi PHI workforce for and during such a transition. Therefore, guided by the Knowledge-to-Action (KTA) framework, the aim Page | iv of this Thesis was to identify the knowledge and skills needs of the PHIs in Riyadh to conduct risk-based food inspections, including any barriers and factors that may influence the effectiveness of the inspection process. Methods This research was conducted in two phases using both qualitative (phase 1) and quantitative (phase 2) methods and utilising a sequential exploratory design. In the first phase, seven semi-structured interviews were conducted with four PHIs, two senior Environmental Health Mangers (EHMs) and the Coordinator of the Food Safety Diploma. The reason for the inclusion of the EHMs and the Coordinator in phase 1 was to obtain different perspectives. Then, the information gathered from these interviews and the knowledge and skills framework of the Food and Agriculture Organization (FAO), were used to inform the development of the survey in the second phase. A survey was deemed to be a best fit in the current study to capture a large cohort of PHIs’ perceptions. A total of 502 PHIs were invited to participate in phase 2 and 301 completed and submitted it, resulting in a 60% response rate. Findings Results revealed that the levels of formal qualification of PHIs in Riyadh are significantly lower than in other developed and developing countries. Female PHIs typically have lower levels of knowledge and skills compared to their male counterparts. In addition, according to the conducted qualitative (Phase 1) and quantitative (Phase 2) investigations, the majority of participants demonstrated only limited levels of understanding and knowledge about Hazard Analysis and Critical Control Points (HACCP) principles, food sampling techniques, food microbiology and the English language as a communication tool with restaurant staff. Page | v Leading towards the anticipated transition to risk-based food inspections in Saudi Arabia, special attention was focused on the professional needs of PHIs and issues that influence their performance, including on-going professional training. In particular, deficiencies in regular training and in the overall training arrangements to PHIs were also demonstrated by the current study. Additionally, lack of job satisfaction was another major finding of the study, with the highest levels of dissatisfaction being expressed with regard to motivation at the workplace, and the lack of support and security provided by the management. It was also found that a large proportion of PHIs in Riyadh regarded the existing food safety laws and regulations are generally inadequate and not sufficiently clear. These were the issues constituting the greatest perceived obstacles for the effective performance of PHIs and an effective transition toward the risk-based inspection approach in Riyadh. In addition, the obtained outcomes could also be generalised to other regions of Saudi Arabia and possibly, other GCC countries. Page | vi Table of Contents Keywords ................................................................................................................................................ iii Abstract ................................................................................................................................................... iv Table of Contents ................................................................................................................................... vii List of Figures ......................................................................................................................................... xii List of Tables ......................................................................................................................................... xiii Abbreviations ......................................................................................................................................... xv Statement of Original Authorship......................................................................................................... xvi Dedication ............................................................................................................................................ xvii Acknowledgment ................................................................................................................................ xviii Conference Participation ....................................................................................................................... xx CHAPTER 1: INTRODUCTION .................................................................................................................... 1 1.1. Background ................................................................................................................................... 1 1.1.1. Food Safety Inspection in Saudi Arabia ................................................................................. 4 1.1.2. Contextual Factors ................................................................................................................. 5 1.2. Context.. ........................................................................................................................................ 6 1.3. Scope…… ....................................................................................................................................... 7 1.4. Research Questions ....................................................................................................................10 1.4.1. Primary Question .................................................................................................................10 1.4.2. Secondary Questions ...........................................................................................................10 1.5. Aims and Objectives ...................................................................................................................11 1.6. Methodology ..............................................................................................................................12 1.7. Thesis Document Outline ...........................................................................................................13 CHAPTER 2: LITERATURE REVIEW ..........................................................................................................15 2.1. Introduction ................................................................................................................................15 2.2. Food Borne Illnesses (FBIs) .........................................................................................................16 2.3. Food Safety Inspection and Inspectors Role ..............................................................................19 2.4. Practice Competencies by Country .............................................................................................23