Evaluation of Mobile Health Education Program of MOH-KSA in Makkah and Arafat during Hajj 1423 H (2003 G)

During Hajj season the Ministry of Health (MOH) adopts a number of measures for health education (HE) of hajjis. One of the important HE methods used to deliver information to hajjis is through mobile health teams; specially equipped vehicles that move around the Holy sites delivering HE messages in multiple languages to hajjis in crowded locations and at places where they gather. This program was started in 1406 H. The objectives of this study were to evaluate the Mobile HE Program of MOH operating in Makkah and Arafat during Hajj 1423, and to determine the factors that affect reception of HE messages by hajjis through this system.

This was a cross sectional study of the mobile HE teams working in Makkah and Arafat during 1423 Hajj season, and hajjis in the vicinity of these teams. All mobile HE sessions conducted in Makkah and Arafat from 4-9th of Dhul-Hijjah were included in the study. A questionnaire was designed to collect information from the HE team and another to collect information from hajjees. A team from the FETP joined the mobile team.

As a rule, four cars that include four teams (of two members each) are designated for the mobile HE campaign. However, due to certain administrative reasons, only two teams had been operating during 4-6/12/1423 H and one team from 7-9/12/1423 H. A car was designated for each team; equipped with two speakers, one cassette player and flashing lights. The MOH emblem was present on both cars, which were provided with cassettes that had recorded messages in 13 languages: Arabic, English, French, Urdu, Persian, Indonesian, Malaysian, Turkish, Chinese, Russian, Swahili, Hausa, and Uzbek_ The recorder and speakers and the quality of the broadcasted sound was excellent in both teams. However, there were no maps of Makkah or Arafat available with either team. All of the team members were males of Saudi nationality, and their education level was secondary school except for one university graduate.

Thirteen mobile HE sessions were observed. The duration of each session was over 1 hour; 8 (61.5%) sessions took place in the morning and 5 (38.5%) in the evening. Access to the location of sessions was difficult in 4 (30.8%) sessions, medium in 6 (46.1%) and easy in 3 (23.1%). Noise level was very high in 1 (7.7%) session, medium in 5 (38.5%) and low in 7 (53.9%). Attention of hajjis towards the broadcasted messages was good in

8 (61.5%) sessions, fair in 2 (15.4%) and poor in 3 (23.1%). The team distributed brochures and leaflets in 5 (38.5%) sessions. The number of hajjis in a 50-meter radius around the site of the session was < 100 in 2 (15.4%), 100-500 in 10 (76.9%), and 500-1000 in 1 (7.7%). During each session HE messages were broadcast in several languages; Arabic in 11, English 6, French 2, Urdu 8, Persian 10, Indonesian 6, Malaysian 5, Turkish 7, Chinese 1, Russian 2, Swahili 1, Hausa 1 and Uzbek 1. Despite the teams' efforts to access different locations, it was somewhat difficult to reach all desired areas, due to the large number of traffic diversions during Hajj, and unavailability of a map of the region.

The most common nationality of hajjis present around the HE session locations was Egyptians in 2 (15.4%), Pakistanis 7 (53.8%), Turkish 2 (15.4%) and Iranians 2 (15.4%).

Information on Hajjis and their perception of the mobile HE messages was abstracted from 1252 valid questionnaires; 1052 (84%) from Makkah and 200 (16%) from Arafat The mean age of respondents was 40.9 years (range 9-90), and 1126 (89.9%) of them were males. They were from 51 countries, classified into seven groups; 43 (3.4%) from Gulf Countries, 526 (42%) other Arab countries, 327 (26.1%) Indian Subcontinent, 108 (8.6%) South East Asians, 60 (4.8%) Iranians, 24 (1.9%) from Sub-Saharan Africa and 110 (8.8%) from Europe, Australia and USA. Their first language was Arabic in 574 (45.8%), Urdu 216 (17.3%), Indonesian 102 (8.1%), Turkish 76 (6.1%), Persian 62 (5%), French 31 (2.5%), English 17 (1.4%) and other languages 126 (10.1%). Among 1205 respondents who answered the question on whether they wanted to hear the HE messages 1136 (90.7%) declared they wanted to hear them, 52 (4.2%) were not interested in hearing them, and 17 (1.4%) did not want to hear them. 669 (53.4%) had heard the HE messages previously, 468 (37.4%) had not, and 56 (4.5%) did not remember. Regarding their opinion on this method of delivering HE 1071 (85.5%) of 1188 respondents thought it was good, 86 (6.9%) somewhat useful, and 31 (2.5%) not useful.

There was no difference between males and females in their willingness to hear the health messages (P=NS). 86.2% of males and 82.5% of females considered the program effective, but the difference between genders was not statistically significant. 86.2% of hajjis who attended the sessions in Makkah considered the method was good compared to 91.5% of those attending them in Arafat (P=NS). The distribution of brochures did not have an effect on hajjis perception of the usefulness of the program (P=NS).

Health education through mobile teams is one of the innovative and effective methods in reaching hajjis in their locations. The mobile HE program is useful in delivering messages to hajjis, despite some administrative and resource limitations. To enhance the effectiveness of this program, there should be enough resources allocated, trained teams and to increase the distribution of brochures and leaflets. It was clear that the hajjis liked this method and the majority wanted it continued. More resource allocation to preventive activities, including health education, will be reflected in decreased expenditures in the therapeutic field. [1,2]

It was recommended that the teams working in the mobile HE program should only be used for the objectives of the program and not assigned to other activities. It was also recommended to increase the number of current languages, and the quantity of distributed leaflets. Training of the program staff should be strengthened and maps of different areas of Makkah and Arafat should be provided.