Assessment of food safety in public psychiatric hospitals in the Eastern Cape province, South Africa

Objective To evaluate the state of food safety practices, staff knowledge, and adherence to food safety regulations in food service units across four public hospitals in the Eastern Cape province, South Africa.Design A cross-sectional mixed-methods study was conducted using purposive sampling. Data collection included self-administered questionnaires, semi-structured interviews, observations, and food safety audits conducted in accordance with national regulatory standards.Setting Four public hospitals in the Eastern Cape province, South Africa.Participants Ninety-one permanent healthcare employees in the public sector, including food handlers, foodservice managers, nurses, assistant directors of support services, and quality assurance officers.Outcome measures The principal areas of investigation included compliance with Regulation 638, adequacy and frequency of staff training, the standards of infrastructure and resources, and perceptions of management support for implementing food safety.Results Quantitative findings revealed that 84% of food handlers expressed a commitment to serving safe and nutritious meals, and 72% reported familiarity with food safety regulations. However, only 62% demonstrated adequate knowledge of hygiene principles, and just 45% understood the importance of maintaining appropriate food temperature control. No formal food safety training was reported between 2013 and 2018. Qualitative insights indicated that suboptimal handwashing was attributed to insufficient supervisory oversight and weak internal control mechanisms. All four hospital food service units had operated without a Certificate of Acceptability since 1994. Despite positive attitudes, institutional, systematic, and regulatory non-compliance reflects systemic governance weaknesses.Conclusions Despite food handlers’ awareness of basic safety principles, persistent gaps in food safety training, inadequate infrastructure, and regulatory non-compliance undermine safe meal delivery in public hospital settings. These systematic deficiencies, rooted in weak institutional oversight, poor enforcement of regulations, and insufficient investment in foodservice governance, pose risks to patient health and institutional credibility. Strengthening food safety in public hospitals requires a coordinated policy response, including infrastructure upgrades, accredited staff training, and enforcement of Regulation 638. Integrating food safety within broader health system accountability frameworks is vital for nutrition-sensitive care in hospital settings.