WHO team promoted the Five Keys to Safer Traditional Markets to meat seller in Jakarta. Credits: WHO/Tri
From August through October 2023, the World Health Organization (WHO) supported a series of activities in three provinces of Indonesia to make traditional food markets safer. The focus of the activities was on raising hygiene and sanitation standards and protecting the health and well-being of consumers and market workers.
Across Indonesia, an estimated 16 000 traditional food markets are a primary source of fresh food and produce for surrounding communities. In a 2020 survey, the Indonesian Ministry of Health (MoH) found that among 448 traditional food markets across 28 provinces, just over 10% met health and sanitation standards. This increases the risk of foodborne disease transmission and the emergence and spread of zoonotic diseases.
To address the problem, WHO helped design and implement a pilot programme in three key locations in Semarang and Bandung districts and Samarinda city, based on WHO’s Five Keys for Safer Traditional Food Markets. The Five Keys offer practical risk mitigation measures and strategies to enhance risk communication and community engagement. They are designed to benefit entire market communities, including management, staff and the public, and to be adapted to meet context-specific challenges.
Using an MoH-developed assessment tool, programme staff first conducted comprehensive analyses of market situations. Results showed an absence of information posters on food safety and health, as well as insufficient assessments of water quality, lack of documented cleaning protocols, inadequate pest control measures and lack of protocols on the handling of live animals. While the knowledge, attitude and practices (KAP) of market workers were aligned with elements of the Five Keys approach, several misconceptions were common, such as the belief that washing hands with water alone is sufficient.
Based on these findings, WHO – in consultation with key national stakeholders – developed a range of information, education and communication materials, which were disseminated through stakeholder trainings, one-on-one discussions with vendors, market announcements and via social media platforms. This was followed by a series of post-intervention KAP surveys and meetings, which found significant improvement in the implementation of hygiene and sanitation standards in each location.
Interactive information, education and communication materials were developed to transfer knowledge across social media platforms and through flyers. Credits: WHO
“From this activity, I have learned that there are several stages for hand-washing, and that sufficient time is needed in order to kill germs,” said Ibu Nurul Uwafik, a meat vendor at Karangjati Market, Semarang District. Across the three locations, vendors' knowledge of key hygiene measures increased from an average 84% before the interventions to 90% after, and 80% of vendors now clean kiosks and floors with water and soap or disinfectant, compared to only 70% before.
The success of the Five Keys programme highlights the value of evidence-based, targeted interventions that raise awareness, change behaviours and promote collaboration among local authorities, market stakeholders and the wider community.
"A health-focused food market goes beyond promoting well-being; it is central to fostering a circular economy, where health benefits seamlessly integrate with the prosperity of the entire community,” said Ence Ling Ibrahim, Trade and Industry Officer, Bandung District. “Through the implementation of the Five Keys approach we have established essential standards in market design that not only minimize health risks but also prevent transmission of zoonotic diseases.”
In the months ahead, WHO will support ongoing capacity building for market communities and will continue to engage the Ministries of Trade and Industry and MoH on integrating the Five Keys approach into the SNI Pasar Rakyat, which enables uniform application of food safety protocols across Indonesia, for healthier, safer traditional food markets.
Written by Indah Deviyanti, National Professional Officer Environmental Health and Climate Change, WHO Indonesia