**Background:** Informal street vending is a critical source of income and food access in many developing countries, yet vendors face numerous occupational and environmental health hazards including lack of infrastructure, police harassment, poor sanitation, and exposure to air pollutants. In South Africa, there is limited research and theory on street trading, making it difficult for authorities to adopt inclusive management strategies. The World Health Organization (WHO) defines a healthy workplace as one where workers and managers collaborate to protect and promote health, safety, and well-being. This study aimed to develop an evidence-based integrated healthy workplace management model for informal vendors in South Africa, aligning with the Occupational Health and Safety Act (no. 85 of 1993) and food hygiene regulations (R638).
**Methods:** The model was developed as part of a larger study conducted in the inner City of Johannesburg. Using a total sampling technique from the COJ health department's 2022 database, 617 informal food vendors from 16 marketplaces were included. The study followed WHO human health risk assessment guidelines and included: (1) walkthrough surveys of respiratory risk factors (infrastructure, hygiene); (2) a close-ended questionnaire adapted from the validated British Medical Research Council respiratory health questionnaire, administered via face-to-face interviews covering demographics, employment factors, workplace practices, and self-reported respiratory symptoms/diseases within the last 12 months; (3) air pollution exposure assessment measuring PM2.5, NO2, SO2, CO, and CO2 using Radiello passive samplers, an EXTECH air quality monitor, and GilAir pumps. A total of 41 air samples were collected (8 PM2.5 area samples, 25 personal PM2.5 samples, and 2 samples each of NO2, SO2, CO, and CO2). Sampling was conducted during winter (the respiratory health risk season) and across all seasons for PM2.5. The questionnaire and walkthrough checklist were piloted among 100 informal food vendors in South Johannesburg for validity and reliability. SPSS descriptive analysis was used for quantitative data.
**Key Results:** Most vendors were cooking vendors (56%). Seventy-three percent worked longer than 8 hours per day, 90% worked 6-7 days per week, and 42% had been working for 6-10 years. Only 37% had access to market communal taps, 35% had internal stall taps (mostly indoor vendors), and only 31% practiced handwashing per WHO standards. Twenty-seven percent relied on neighboring businesses or brought water from home. Upper respiratory symptoms were more prevalent than other respiratory problems. Statistically significant associations with upper respiratory symptoms (cold, sore throat, nasal congestion) were found for: work location (p < 0.001), work duration in hours (p < 0.001), work duration in days (cold/sore throat p < 0.001; nasal congestion p = 0.001), work duration in years (cold p = 0.008; sore throat p = 0.015; nasal congestion p = 0.005), type of cooking fuel (p < 0.001), informal vendor training (cold p = 0.003; sore throat p = 0.021; nasal congestion p = 0.023), and frequency of hand hygiene practice and mask use (p < 0.001). Cooking gas was the most common fuel (45%), followed by electricity (13%), open fire (11%), and combinations (7%). Outdoor markets had greater concentrations of area air pollutants (PM2.5, SO2, NO2, CO2) than indoor markets, with cooks being most at risk. Spring and winter showed higher PM exposures than summer and autumn. Most vendors used incorrect respiratory protective equipment (surgical or cloth masks). Seventy-five percent of trained vendors came from indoor marketplaces, mostly from the cooking category, and most training occurred only once per year.
**Clinical Implications:** The findings demonstrate a clear need for integrated management of informal vending that addresses physical work environment infrastructure, vendor knowledge/attitudes/practices, and direct health monitoring. The proposed five-component model includes: (1) reviewing and consolidating informal vendor legislation to address gaps (e.g., R638 regulations not adequately covering informal stall structures); (2) restructuring vending sites with proper mapping, stall design, separation of food from non-food vendors, and provision of basic services (water, electricity, sanitation); (3) space allocation and occupancy using e-services for transparent registration and permitting; (4) vendor skills development including repeated, culturally appropriate training on hand hygiene, protective equipment, air pollution risks, and food safety; (5) sustainability through continuous monitoring, occupational health risk assessments, environmental health sampling, primary health care services (mobile clinics, respiratory health assessments), and management model performance audits. The model integrates occupational health and safety into the public health system, aligning with WHO and ILO recommendations. Key challenges include potential overload of primary healthcare facilities and the high cost of infrastructure provision, suggesting phased implementation. Political will, leadership, social dialogue, and partnership are identified as critical success factors.