Foodborne diseases are an important cause of gastrointestinal illness in Pacific Island Countries and Territories (PICTs). They are known to have significant health and economic consequences, however, reliable data on the various causes and the foodborne sources associated with specific disease are limited. This lack of data limits our understanding about foodborne diseases in the PICTs, their burden and impact on public health, and possible ways to improve food safety. There is an urgent need for better surveillance data. Improving country surveillance systems and the capacity for outbreak investigations will help address these limitations. This paper is the outcome of individual research and a four-day meeting of technical experts convened to develop practical options that PICTs might consider to enhance foodborne disease (FBD) surveillance systems. It is anticipated that the content and recommendations outlined herein will assist in establishing a regional strategy for Pacific FBD surveillance. It gives a framework on how to develop and enhance FBD surveillance for both the regional and national levels and provides examples that countries in the Pacific may consider to enhance their foodborne disease surveillance systems.