Advancing Food Safety Intelligence in Ghana: An Evaluation of Ghana’s Foodborne Disease Surveillance System

Introduction: Robust surveillance systems are essential for food safety governance, yet formal evaluations of national systems in West Africa are sparse. The FDA's surveillance system had never been systematically assessed, limiting evidence for targeted improvements.Methods: A mixed-methods cross-sectional evaluation (April–May 2025) used the CDC Updated Guidelines for Evaluating Public Health Surveillance Systems. Data collection included 13 key informant interviews, observational field visits to five sentinel sites, and review of surveillance records and policy documents (2020–2024). Analysis integrated qualitative thematic coding with descriptive quantitative summaries.Results: Eight outbreaks (128 cases) were detected over five years, primarily in schools. Sentinel site enrollment was low at 47/200 (23.5%), with no sites reporting in April 2024. Case-based form completion was 32/50 (64%), with systematic gaps in laboratory results (<20% present) and food history (40% absent). Outbreak-specific reporting was timely (8/8; 100% on schedule; median 2 days from detection to data entry), but routine weekly reporting was absent. Despite these limitations, the system supported outbreak response and policy actions, including facility closure and development of the national Food Safety Emergency Response Plan.Conclusion: The system functions effectively for outbreak detection and response, but operates below standard for continuous disease burden monitoring, data quality, and routine surveillance timeliness. Priority investments include establishing feedback mechanisms to sentinel reporters, transitioning to electronic reporting integrated with DHIMS2, expanding coverage to public facilities, and enabling formal sensitivity estimation through laboratory linkage.