Health and Safety Practices as Drivers of Business Performance in Informal Street Food Economies: An Integrative Review of Global and South African Evidence

Background: Street food vending provides vital employment and nutrition in low- and middle-income countries (LMICs), but poor health and safety compliance pose significant public health and business risks. Despite growing policy recognition, the link between hygiene practices and vendor performance remains underexplored. Objective: This integrative review examines the influence of health and safety practices on the business performance of informal street food vendors, with a particular focus on both global and South African contexts. Methods: A total of 76 studies published between 2015 and 2025 were retrieved between June 2024 and May 2025 and analyzed using an integrative review methodology. Sources were identified through five major academic databases and grey literature repositories. Thematic synthesis followed PRISMA logic and was guided by the Health Belief Model (HBM) and Balanced Scorecard (BSC) frameworks. Results: There was a marked increase in publications post-2019, peaking in 2023. Sub-Saharan Africa accounted for the majority of studies, with South Africa (28%) and Ghana (14%) most represented. Among the 76 included studies, the most common designs were quantitative (38%), followed by qualitative (20%), case studies (14%), and mixed-methods (11%), reflecting a predominantly empirical and field-based evidence base. Thematic analysis showed that 26% of studies focused on food safety knowledge and practices, 14% focused on infrastructure gaps, and 13% focused on policy and regulatory challenges. Of the 76 studies included, 73% reported a positive relationship between hygiene compliance and improved business performance (such as customer trust, revenue, and operational resilience), based on vote-counting across qualitatively synthesized results and business outcomes. The review identifies a conceptual synergy between the HBM’s cues to action and the BSC’s customer dimension, highlighting how hygiene compliance simultaneously influences vendor behaviour and consumer trust. Conceptual saturation was observed in themes related to hygiene protocols, consumer trust indicators, and regulatory barriers. Conclusions: Health and safety practices function not only as compliance imperatives but also as strategic assets in the informal food economy. However, widespread adoption is impeded by structural barriers including limited infrastructure, education gaps, and uneven regulatory enforcement. The findings call for context-sensitive policy interventions and public health models that align with vendor realities and support sustainable, safe, and competitive informal food systems.