A Critical Analysis of the Project Piaxtla Health Initiative

This essay provides a critical analysis of Project Piaxtla, a primary health care program in rural Mexico, focusing on its participatory planning approach. The program, led by David Werner, aimed to address alarming health issues and high child mortality rates in the 1960s. Initially focused on curative care, the project evolved to prioritize preventative and promotional measures, including immunizations and hygiene education, as the community's needs shifted. The essay examines the roles of village health promoters, the Piaxtla team, and various community members in the project's success, highlighting actions like the farmworkers' maize bank and women's initiatives. It also discusses the impact of external factors, such as NAFTA and the Zapatista uprising, on the project's progress and the involvement of government authorities and NGOs. The analysis underscores Project Piaxtla's efforts to address health inequities stemming from socioeconomic disparities, particularly concerning access to healthcare, land rights, and clean water. While acknowledging the project's achievements, the essay also identifies its limitations, such as low crop harvests and the need for additional resources, providing a comprehensive overview of the program's impact on the community's health and well-being.

Running head: CRITICAL ANALYSIS OF PROJECT PIAXTLA
Critical analysis of project Piaxtla
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CRITICAL ANALYSIS OF PROJECT PIAXTLA
One of the greatest risk to the society in the present day scenario is the health inequities
and disparities prevailing across the different societal stratifications. Although, different global
and local health authorities have taken different initiatives for improving the access to health care
for different sectors of the society, there still are a plethora of barriers that restricts optimal
inclusion for the socially disadvantaged groups. Researchers are of the opinion that the planning
approach of the health promotional projects often is one of the barriers affecting the success of
the project (Chisholm 2016).
Participatory planning approach has emerged as one of the most effective and functional
community program planning approach with a much higher success rate do the optimal
participatory inclusiveness. According to Craig et al. (2016), it has to be mentioned that for the
contributing factor behind the higher success rate of participatory planning approach is the fact
that is a planning paradigm that involves the entire community in the process. This particular
approach to community development takes into consideration harmonizing the point of views of
all of the individuals into the planning and implementation in order to address the exact issues of
the community and in a manner that will be most relevant and acceptable manner to the
members of the community. In case of health developmental promotional programs, the inclusive
participation of all individuals is very important for optimal success of the project. Hence,
participatory planning approach has been considered to be very effective for health programs.
This essay will attempt to explore and critically analyze project Piaxtla, a health program
developed on the foundation of participatory planning approach.
Project Piaxtla is a primary health care program which is operated by the local villagers
in the rural Mexico, near the foothills of the Sierra Madre mountain range in the state of Sinaloa.
This program had been intended to provide primary health care to the large, coarse and scantily

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populated region under the guidance and leadership of David Werner. As per the reports, the
health status in the early 1960s have been alarming and child mortality rates have also been
considerably high; the harsh physical environment had not been the only contributor to their
devastating health issues (Fernández Velázquez 2016). On a more elaborative note, the main
contributing factor behind the health issues and high mortality rate of the locals had been the
absolute lack of health care services, a dire need which the project had attempted to fulfil. The
primary or immediate need that had been identified for the project had been curative care
provided to each and every individual of the community. It has to be mentioned in this context
that the unfair distribution of lands in the Ajoya associated region and the discriminating land
policies such as the North American Free Trade Agreement, the gap between the rich and poor in
the region continued to widen and also led to considerable violence, unemployment and falling
wages. As a result of this, the diseases of poverty dominated the area with one third of the
children dying before attaining the age of five, and hence, the needs of the community in the
very beginning phase was identified as the need for curative care. And in this phase the needs
assessment had been based on the current health status of the community and assumptions.
However, with the progress of the project, the health care team that had been serving the target
community became aware of a shift in the primary needs of the community (Hopwood 2015). It
had been discovered that the one of the greatest concerns for the community had been the
recurrent diseases and its aftermath. Hence, the need for preventative and promotional measures
for warding off recurrent diseases became a predominating need of the community. And the
focus of the project shifted from delivering curative care to providing preventative and health
promotional measures such as immunizations, personal hygiene and access to purified water and
medicines. Eventually the focus of the project shifted further to a situational analysis based needs

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assessment and the focus shifted towards the organized action based program. Hence, the needs
assessment in the beginning phase of the project had been only focused on the curative care later
on changed to a need of community rehabilitation with the help of learner-centered, discovery-
based, problem solving approach to health education (King et al. 2018).
In a participatory approach to the health promotion project, it is very important for the
participants of the project to be critically analyzed. As mentioned above, the project Piaxtla had
been a participatory project where each and every individual of the society had been given the
opportunity to contribute to the project. Village health promoters can be considered as the first
and most influential participatory group in the project and they had been trained in using
participatory, learning-by-doing methods in order to help them attain the skill set required to
treat and manage the common illnesses that plagued the particular region. Researchers are of the
opinion that in the early phases of the project these village health promoters have been the
facilitator of change in the health status of the community (Lawless et al. 2014). However,
consistent with the changes in the primary health needs of the community the participants of the
project also changed with respect to organized social rehabilitation of the target community.
Elaborating more, in the later phases of the project the need for a more socio-political action
oriented health program to provide preventative and promotional care delivery rather than
curative care. Here, the workshops with participants such as farmers, mothers and school
children contributed to the problem solving approach to health education in the community.
Three very important participatory actions taken by the common men and women acting as the
key participants with the help of Piaxtla team led by David Werner, had been the farmworkers-
run maize bank, cooperative fencing program, and the women uniting against men with the
drinking issue; which had been a considerably significant issue in improving the health status

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and living condition of the team. The Piaxtla team was another participant entity that had a
profound impact on the project, and this team had comprised of David Werner as the leader and
few educated deserving candidates chosen from the villagers as health advocates. The most
significant actions had been taken by these two fundamental groups of participants, the Piaxtla
team and the villagers, however they had been able to attain support from a few other agencies as
well. A few regional newspapers had been persuaded to lend in helping hand against the bar
protest movement of the project and along with that the committees from the Piaxtla team and
the farmer’s associations have also been successful in gaining support from the Ministry of
Agrarian Reform in Mexico City which helped the poor farmers of the village initiate the
claiming of their lands. In the next phase, the impact of NAFTA or North American free trade
agreement has had a significantly detrimental impact on the cooperative participatory action by
the Piaxtla team and the farmworker’s organization. This on the other hand led to the uprising of
the Zapatista National Liberation Army in Chiapas in the 1994. It has been argued by the
Munyewende, Rispel and Chirwa (2014), the mini-revolution facilitated by the EZLN has forced
Mexico’s ruling party to respond seriously to popular demand for social justice. In support the
Ortega (2015) has stated that this rebellious organization from the Mexico’s poorest, most
exploited indigenous people has contributed significantly to defend the rights and health of the
Mexican people than any event since the Mexican Revolution. It has to be mentioned in this
context that, the Chiapas resurrection had been a considerable participant that has contributed
significantly in the success of the project Piaxtla. According to the Powell Davies et al. (2017),
the Chiapas insurrection has helped the Piaxtla health team and farmworkers in far off Sinaloa to
retain the gains of their 20 year struggle for land and health. In order to illustrate the individuals
that could have participated to the cause of project Piaxtla, the government authorities and the

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local law and order supporters need to be discussed. It has to be mentioned that the help from the
local forces and the government bodies have been indifferent to the suffering and the alarming
lack of social justice in the target population and the land-politics can be a considerable
contributor to the same. Along with that, the support from social work organization and NGOs
funded by the United Nations and similar global human rights welfare authorities have been
significantly lacking in the project. Rojo (2014) have argued that supportive participation from
these two key sectors could have contributed significantly to success of the project and have not
participated.
Inequity issues:
Project Piaxtla had been developed as a measure to address the alarming rise in inequality
issues prevailing in the health care context, but stemmed from the socioeconomic inequities and
social justice issues. First and foremost, the most critical issue that has been addressed by the
project had been the access to health care services. The regional population had lived through,
extreme poverty, unemployment and oppression by the wealthy communities, hence, it resulted
in the dominance of poverty related health issues and its reoccurrence which further led to higher
mortality rate among the poor villagers and skyrocketed the child mortality rates. The poor
community had no medical attention before the project due to this region being “a land where
there is no doctors” and they could not access the medical attention outside from the wealthy
communities either. This issue of inequity was effectively addressed by the work of the Piaxtla
team and the health promoters (Scrinis et al. 2015).
The issue of land and social justice cannot be ignored in this context either as it had been
the root of the violence unemployment and poverty in the region. With the shift of the project

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Piaxtla from just curative care to health with social support, the oppression related inequity
issues had been identified and addressed excellently by the project. First and foremost, land
acquisition and farmer run maize bank had been a milestone achievement for the project Piaxtla
to improve the issue of social justice and oppression by the wealthy communities. This inequity
issue was addressed by the project with the help of farmworkers organization until the NAFTA
policy. Post the effect of this policy, the project Piaxtla with the help of the Chiapas resurrection
could regain a fraction of the lands again and it contributed significantly to the improvement of
the living conditions and in turn the health status of the target population. The co-operative
fencing programs had also been a significant stand taken by the project to help eradicate the
inequality issues related to land and social justice (Wakerman 2018). Lastly, water supply had
been controlled by a wealthy man which resulted to the poor villagers having little to no access
to clean water and had been a considerable contributor to water borne diseases in the community.
The project Piaxtla also addressed this particular issue with persistent efforts which resulted unto
the introduction of a public water system controlled by the community. However, despite the
commendable efforts taken by the project, there still are a few arguments highlighting the gaps
left behind by the project. The crop harvest had been very low and with the minimal support
from the local and federal government, the project had to be shut down and hence a few inequity
issues such as shelter and resources were left unaddressed. Along with that, the progress attained
by the project was also threatened when the community had to migrate due to persistent issues.
The training and educational needs of the health promoters were not also properly addressed by
the project either which led to unrest as well (Kramer 2014).
The project Piaxtla has taken an evolutionary turn ever since its inception. The project
had been rolled out to make the villages in West Mexico self-sufficient by educating the villagers

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upon the various aspects of healthcare management. The project had been supported though the
local villagers, who participated in the initiative and helped in the propagation of the healthcare
objectives. The project required the participation of each and every villager who were assigned
with the tasks of disseminating relevant healthcare and prevention information within the
local population. The participation of the local villager in the health promotion movement was to
be brought about by word of mouth promotion. Out of the villagers, few were provide with the
designation of health advocates who were eventually provided training on management of the
common health issues such as cough, cold and fever. The participatory planning was further
supported through effective policies and guidelines a few of which had been e mentioned in the
project handbooks (Lawless et al. 2014).
Some of the most important attributes highlighted though the participatory planning
approach of the project was to make the villagers aware of the importance of vaccinations. It had
been seen that the child mortality rate was high in the Ajoya village as much of the children
could not survive till the age of 5 years. Hence, through participatory planning approach
majority of the villagers were brought under maximum healthcare inclusion. The process was
completely directed by the local leaders. Thus, much disagreement in this regard was not seen.
Through the PIAXTLA project some of the villagers who were already trained in the areas of
healthcare delivery and disease prevention would in turn train few more villagers (Manzano-
Sarabia et al. 2018). The main principles behind the project were to support maximum social
inclusion alongside promoting autonomy and empowerment of the villagers (Powell Davies et al.
2017). Through promoting maximum participation of the villagers the goal was to disseminate
sufficient health related information which will help the villagers in taking important decisions.

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The participatory approach was further utilized in fighting for land and social justice. It
was found that most poor rural families owned little or no land. Additionally, the land owned by
them was of inferior quality. Hence, the poor peasants had to work on the farm land of few of the
local owners. In order to consume the vegetation grown on the land of the rich villagers, the
poor peasants were charged interest at the rate of 300%. Therefore, the idea of maize bank was
developed where the farmers and the local health workers utilized a part of the river bottom land
for growing their own vegetation. However, the ejido system has failed to prevent or protect the
small farmer’s land rights. Hence, the PIAXTLA shifted its concentration from curative care to
social action. Here, the group of villagers joined to form an ejido or communal land holding
(Kramer 2014). Some of the movements such as the cooperative fencing program along with
protesting to take control of the village water from wealthy men have been seen to yield positive
results, where the process had been supported by leaders and people from supporting villages
along with Piaxtla team.
On a concluding note, it has to be mentioned that the project Piaxtla had been a
commendable effort by David Werner which had contributed to save hundreds of lives in the
Ajoya region of Sianola. The contribution of the farmworkers association and the Piaxtla team
with the guidance and leadership of David Werner singlehandedly improved the health status and
life expectancy of the poor villagers by addressing the health inequities and oppressions issues
resulting in the inequities. However, the project had been also criticized for the areas that it had
not been able to address and the gaps of the project. Although, it has to be mentioned that the
lack of government and global support sand political issues had the most contributing impact.
Although, it has tied most areas of production and development to the global market in a way
that benefits powerful interests and weakens the bargaining power of the poor. Hence, it has to

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be commended for the first few steps it had taken to improve the life of the poor villagers in the
regions and it can be a fertile ground for further such projects to follow on similar causes.

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