PHCA9505: Participatory Planning Approach to Project Piaxtla

This assignment critically analyzes Project Piaxtla, a rural primary health-care program in western Mexico, using a participatory planning approach. It examines how the project assessed needs, who participated (and who didn't), how issues of inequity were addressed, and the congruence of processes with participatory planning principles. The analysis covers the project's evolution through different phases, from curative care to preventive measures and advocacy for basic rights. It highlights initiatives like the farmworkers' maize bank and cooperative fencing program, which aimed to address economic inequalities and empower the community. The study reflects on the challenges faced, including potential opposition from privileged groups, and emphasizes the importance of community involvement and addressing the root causes of poor health to achieve sustainable improvements.

Running head: PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 1
Primary Healthcare Practice in Developing Countries
Name
Institution

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 2
Primary Healthcare Practice in Developing Countries
Aim
 Demonstrate an understanding of the principles and processes involved in participatory
planning.
In this respect, there was a need to adjust the focus of the program again to a more organized
action with an aim of defending the basic needs and rights of people
Objectives
 How needs were assessed and changes over time in needs assessment
 Who participated in the program and who may not have participated
 How issues of inequity were addressed or not addressed
 The extent to which processes and actions were congruent with principles and processes
of participatory planning
Introduction
In essence, project Piaxtla is a rather rural primary health-care program that was set in
western Mexico and is run entirely by local villagers. Apparently, the program was set to serve a
larger and rugged sparsely populous area in the state of Sinaloa. However, in recent times these
areas have been traversed by mule trails as well as footpaths. This program was designed to
function in Ajoya which is considered one of the largest areas in the entire of Piaxtla.
Noteworthy, the program involved David Werner as an advisor as well as facilitator since the
initiative took off.
The program was started when the disease of poverty had taken a high notch in the area
and dominated the health scene. In this light, there were reported cases of children dying of
chronic undernutrition as well as diarrhea and infectious diseases even before they hit age five.
Nonetheless, there were cases where seven in ten women complained of anemic while ten could

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 3
die after giving birth. This problem spread widely as a result of inequitable distribution of
resources such as the land, wealth, as well as power. Most of the families in this area owned
either littler piece of land. In case these families owned land, then it was basically of inferior
quality. In the contrary, small portion of people were regarded as rich and therefore owned large
tracks of lands which were fertile as well as huge herds of cattle. In essence, this community was
in full control of the entire community doings. They were responsible of blocking any fruitful
demands by the poor people of their constitutional rights to own land and therefore started
violence any time whenever they wanted to keep up their dominant position in the society. In this
regard, the issue surrounding land distribution has been a critical issue for the last couple of
decades now. It was until recently that the Mexican agrarian reforms legislations which then
could include. This system would then involve the group of villages joining together to form
what is rather called the communal landholding or the ejido.
Question for Reflection
Primarily, the development project had one of the best politically both right and left,
therefore, encouraging a rather personal incentive as well as a higher production of the overall
private ownership yet guaranteeing equity of land ownership. Nonetheless, the system has
managed to work more in a theoretical manner rather than factual. The project is therefore
designed and managed in a formal plan to curb the level of poverty in the society with an aim of
bettering the overall health care of the poor families and level them with the rich families in the
society. Additionally, the program did involve a wider range of stakeholders to make sure that it
was successful particularly making sure that all the required information is available. From the
level of my experience, I foresee plenty of challenges in making the program a success
considering the fact that it is likely to receive opposition from the rich families.

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 4
How needs were assessed and changes over time in needs assessment
Essentially, the project is set to improve the overall health to evolve in different phases
often referred to as the three phases. We ensured that the project had no political agendas
particularly in the earlier stages but then focused on a rather curative care that is considered as
the main and immediate needs of the people. Those people that are tasked at promoting the
village health were trained by the use of a participatory which included leaning by doing
methods. Through doing this, they would be competent especially in treating common diseases
as well as injuries. As time went on, we became more aware of the recurring nature of the same
illness. To respond to this issue, there has been a shift of focus to a rather preventive as well as
promotive measures which includes immunizations water system and latrines. As a result there
were reduction of such ailment particularly during the second phase of the designed program and
therefore the overall health improved drastically (Westrup, 2017). Apparently, few children died
of whooping cough and fewer were affected by polio. Nonetheless, there were still cases of
women and children who were malnourished particularly during dry seasons where harvests
were little.
Additionally, mortality rates among children from a poor background especially those
that were landless, and underpaid, underserved remained high. In this respect, there was a need
to adjust the focus of the program again to a more organized action with an aim of defending the
basic needs and rights of people. Notably, this enabled the village health program to develop and
take a notch higher from a rather creative care to a more inclined to preventative as well as
promotive measures in a more sophisticated action. A more learner-centered, problem-solving
approach to health education partly resulted in a rather shift of the main focus of the program
from a more conventional one to an organized action plan.

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 5
Who participated in the program and who may not have participated?
Primarily, the workshop was mainly led by health promoters where farmers,
schoolchildren, and mothers would prefer stating off with a rather situation analysis.
Additionally, they would start with community diagnosis where the main participants were asked
to identify and later discuss the problems that are related to health in the communities they come
from and in what ways these problems may interrelate (Avgerou & Walsham, 2017). Instead of
concentrating on a single cause of a child death, these groups were designed to explore a variety
of causes that may as well be leading to children dying in the community (Werner & Sanders,
1997). Apparently, most links to these causes would then be recognized as cultural, biological,
political, economic, and or rather power. During the initial stages of the program at a time when
the main focus was based on a rather curative as well as preventative, people tend to have
identified the root causes to be biological, cultural or rather physical.
The chain that was traced to the death of children and related to diarrhea may be from gut
infections, germs that were mainly carried from feces to mouth as well as lack of latrines and
clean water. However, as the group tended to dig deeper, they discovered that the causes as well
included political and economic connections. After coming up with the root cause of children’s
death, the group resorted to finding a lasting solution to the problem (Smith & Goodwin, 2017).
Apparently, storytelling, role plays, or rather involving a wide variety of audience could be used
to come up with solutions for such problems. A strategy for action could then be developed after
a mutual agreement on the circumstances as well as the right timing (Paton & Johnston, 2017).
How Issues of Inequity Were Addressed or Not Addressed

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 6
In essence, there was a clear need by the health promoters as well as the community to
have a deeper look at the underlying causes of the poor health and therefore were forced to begin
looking for genuine ways in the could break the chains that lead to sickness and death (Legacy,
2017). Apparently, this was done through a collection action and therefore started with some of
the links which could be easily dealt with particularly at the local level (Moallemi & Malekpour,
2017). Moreover, they considered those that possessed fewer risks especially of a violent
response from the structure of power. However, while carrying out the study the group realized
that there might be an apparent opposition by those in privileged positions in trying to block the
poor from correcting their inequalities status (Norris, 2017).
Primarily, most of the actions that were organized through Piaxtla health program were
mostly considered to have a relationship with the way the poor people were exploited and
cheated on a daily basis. Some of the initiatives and actions that were taken to address this type
of inequalities included:
 Lowering fares to the local buses route to a rather legal rate that was fair to all the people.
 Coming up with a farmworkers bank
 Instigating a cooperative program designed for fencing
 Organizing initiatives and group that would help to shut down public bars with an aim of
reducing violence and curb drunkenness.
 Initiating a systematic protest with an aim of boosting the overall control of water supply
that would not be interfered with by the wealthy and therefore controlled by the
community.
In this work, we will, therefore, try to illustrate these initiatives.
The Farmworkers-Run Maize Bank

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 7
One of the most unfair systems that the group planned to deal with was the system of
loaning maize. Due to the little amount of maize produced by the poor farmers in the villages,
most of these farmers exhausted their maize and therefore were forced to borrow from the rich
farmers. The poor farmers are then given a grace period of about six months to repay the loan.
Most of these poor farmers are left with no maize after paying back the loan failure of which
their properties would be seized.
In order to end this form of exploitations, Piaxtla team was tasked with healing the
helping the poor farmers coming up with a cooperative maize bank. These banks would,
therefore, charge lower interest rates compared to those that used by rich farmers. This initiative
was finally embraced across the entire village and therefore helped in a big way in improving the
economic well-being of the poor families and thus facilitating a better nutrition and health in the
long run (Pugh, 2017). Noteworthy, this initiative helped in fostering a greater cooperation as
well as a high level of accountability which helped the farmers acquire management and
accounting skills. Additionally, poor people gained courage of bettering their current situations
in the society. Through coming up with this kind of system of banking, the poor people could
then lean a better way of fighting for their rights (Brownson, Colditz, & Proctor, 2017). This
helped the community to become strong and therefore breaking the dominance that was initially
enjoyed by a small portion of wealthy individuals.
The Cooperative Fencing Program
There was the tendency of the rich people’s cattle invading the poor men farms and
therefore there was an urgent need to find a rather cost-effective means of fencing their farms
Initially, the poor men used to borrow fencing materials such as a wire from the rich men and

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 8
therefore in return they would provide grazing rights particularly, on the farms that they had
cleared.
The Piaxtla health team had, therefore, to come up with a possible solution to this
problem. This included facilitating an initiative where they encouraged the poor farmers to join
together and form a cooperation thus fencing the entire hillside. All the poor farmers could,
therefore, be in a position of planting their crops in this enclosure (Kimuyu, 2017). To make sure
that the project was funded, the group had to seek financial assistance from the non-
governmental organizations. The loans were paid back to the non-governmental organizations
through charging the rich families for grazing g rights. After paying all the loans the grazing fee
could then act as a source of income to the poor farmers was then used to provide food and
healthcare needs for these farmers.
The money which was paid back by the farmers in the first slot would then be used to
loan another group of poor farmers (Ehler, 2018). This aspect of revolving funds facilitated self-
sufficiency of poor farmers in the entire village with time. In essence, the overall gap regarding
wealth and power between the rich families and the poor families in the society decreased and
therefore there was an improvement in the health among children from poor families (Lovan,
Murray, & Shaffer, 2017). This method proved very decisive and therefore encouraged other
poor families to join this initiative and formed a big team in the long run.
Uniting Against Drunkenness
It is no doubt that the issue surrounding drunkenness has been a major cause of violence
in the families and therefore women sought to practice their powers in addressing this problem,
particularly among the males (Westrup, 2017). This issue needed to be solved considering the
fact that men always bought alcohol with the money that is meant for food, therefore, damaging

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 9
the health condition of women and children. Women, therefore, came up with various initiatives
to discourage their men from drinking. While this led to some women being jailed, it facilitated
even more protest and therefore all the health workers were released.
The Extent to Which Processes and Actions Were Congruent With Principles and
Processes of Participatory Planning
In essence, participatory planning and processes involve a particular community
undertaking a given task or step with an aim of diagnosing a problem and finding a suitable
solution to that problem. In regards to this topic, the process was congruent to the actions
undertaken since it aimed at solving health issues through stabilizing the poor families and
making sure they get access of basic needs and in the long run bridging the massive gap between
the poor families and the rich families (Sager, 2017). Apparently, this was achieved through
Piaxtla health team. Notably, by reducing the gap between the poor and the rich increase the
quality of health to the poor people since they will have access to food and basic needs.
Conclusion
It is not easy measuring the level of success that a project such as Piaxtla could bring to a
particular community and its overall contribution to the health which is the ultimate determinant
of this project. The organizations that grew out of this program particularly that which empowers
the poor to be self-dependency facilitated a better healthcare system. Although there are a lot of
challenges that are likely to face the project, it is important for the team to make it a success to
improve the overall health care of the surrounding area. Some of the challenges include an
opposition by the rich families trying to reinstate their position in the society.

PRIMARY HEALTHCARE PRACTICE IN DEVELOPING COUNTRIES 10
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