Ethiopia's Unsafe Food System – A Systems Perspective of an Emerging Public Health Crisis

Available evidence suggests serious food safety concerns in Ethiopia. Most available studies focus on single contamination types, geographies, or commodities. This analysis synthesizes food safety research in Ethiopia taking a food system perspective. Our synthesis identified four thematic areas of concern (1) aquatic ecosystems and water as an agricultural input, (2) chemicals and heavy metals in agriculture and agricultural outputs, (3) mycotoxins, and (4) contamination in food products. We conclude with key actions in the short, medium, and long term and identify key stakeholders to take action to improve food safety. A safe food system requires collaboration. In Ethiopia, this requires multisectoral collaboration across federal ministries (horizontal) with all levels of regional-state governance (vertical) as well as the private sector. Regulation alone is insufficient; collective action is essential. The Food and Nutrition Council should lead coordination, ensuring policy coherence and navigating socio-political trade-offs. In the short term, a multisectoral committee should be established for immediate action. This committee should work with the research community to advance the evidence base. Medium term efforts should involve regional universities in monitoring of contamination and evaluating food safety actions. While long-term commitment is needed to address the issues identified, effective action can begin now, based on available evidence.