Project Piaxtla Case Study: Evaluating Participatory Planning Impact

This case study examines Project Piaxtla, a primary healthcare program in rural Mexico, through the lens of participatory planning. Originating in 1965, the program addressed issues like malnutrition and high child mortality rates by involving local villagers in decision-making. The project evolved through three phases, initially focusing on curative and preventative care, then shifting to social-political action to address underlying issues of inequity in land ownership and access to resources. Strategies included establishing maize banks, cooperative fencing programs, and advocating for land redistribution. The success of Project Piaxtla highlights the importance of community involvement and addressing social determinants of health in improving the well-being of marginalized populations. Desklib provides access to similar case studies and resources for students.

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Analysis of Project Piaxtla Using a Participatory Planning Approach
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Introduction
Piaxtla project is a program based on primary health care provision in the rural setting of
Mexico. With its entire activities being conducted by local villagers, it ended up deriving its
name from a river located in the nearby foothills of Sierra Madre ranges (Delaney, 1977). Dating
back to 1965, the program was formulated to serve the sparsely populated Sinaloa state which is
also large and rugged. The program has deeply established its roots in Ajoya, which is the largest
village within the area covered by Piaxtla. Since it was incepted, David Werner has shown
intensified involvement to the program’s affairs as its advisor and facilitator (Packard, 2016). At
its initial stages, it was dominated by diseases of poverty which majorly comprised of chronic
undernutrition and diarrhea. It had also been observed that out of three children, one of them died
before attaining the age of five more so due to the fore mentioned diseases. Additionally, 0.7%
of women were anemic with 0.1% of women losing their lives during or after child birth. These
conditions brought about untold social injustices and inequity (Ekins, 2005) as will be discussed
later on.
Assessment of needs and changes over time in need assessments.
Participatory planning majorly involves definition, proposals and enforcement of
management plans basing on issues that are of common interest in the community (Weil, et al.,
2013). Project Piaxtla entailed the same approach as the local inhabitants managing the program
made decisions based on the common problems that were affecting a larger section of the
community. Participatory approach theory therefore derives its main concerns on issue that are of
effect to the majority in the area of study (Blumenthal & DiClemente, 2013) and seeks to come
up with various models that will help resolve the problems identified.

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There were various approaches adopted in assessing the needs that prevailed over time in
the Piaxtla project. The needs identified at one particular time were however not constant
throughout as once resolved, new categories of needs came up and needed the managerial team
to divert their attention to them. To begin with, the prevailing and deteriorating health situation
in Sinaloa as previously reflected by the initial findings of the project brought about inequitable
and unfair distribution of wealth, land and power (Brachet-Márquez, 2014). Majority of poor
families located in the rural areas and locally referred to as campesino had little or no land to call
their own property. Those lucky enough to own land possessed that which was of inferior
quality. On the contrary, rich local families (a handful of them) were the owners of massive
tracts of land and specifically the river valley land which was fertile (Whiteley, et al., 2008). In
addition, they owned large numbers of cattle and were able to access quality healthcare anytime
that they needed it. It therefore goes without saying that majority of the residents were being
denied their constitutional rights and basic needs. Whenever they attempted to organize
themselves and demand for what is rightfully theirs, the few rich families completely blocked
their attempts as they had complete control over the community council of Ajoya.
Strategies that were aimed at improving the health status by Project Piaxtla assessed the
prevailing needs and evolved in three phases. The earliest phase had little concern on political
agenda and was therefore concerned with improvement of curative care as well as preventive
care. Local health promoters located in the village were educated and trained by means of
participatory approaches, and ‘learning by doing’ methods which greatly improved their
competency in treating common injuries and illnesses. Needs identified here were mainly linked
to cultural, physical and biological situations. If for example a child died due to diarrhea, the
needs that medical promoters diverted their attention to included seeking ways to eradicate;

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dehydration, gut infection, diarrhea, contamination through faecal matter, shortages of latrines,
and no supply to clean drinking water. As the prevailing needs were gradually eradicated by the
initial move, the program’s focus on the other hand gradually shifted to promotive and
preventive measures. Such measures included provision of latrines, water systems and initiating
vaccination moves. The second phase was also productive as various illnesses that were initially
common in the locality faded away and there was notable improvement in the overall health of
the residents. Minimization of tetanus, whooping cough, polio and measles which had been
identified as the primary need of the second phase of the project was actualized.
However, the number of children and women who were malnourished remained high and
more so in the years when the harvests were poor (Ruiz, 2010). Mortality rates of children below
five years was still sky rocketing among children thriving from families with poor backgrounds.
Majority of these families remained landless, received poor wages and were exploited by the few
rich in many ways. These conditions therefore resulted to change in the program’s focus. Its
main concern became fighting for peoples’ needs and basic rights. Thus evolution therefore
brought about social-political action. The key drivers of the shift to organized actions were
discovery based and learner centered approach of solving problems in health education. In the
third phase therefore, the local residents were able to link their prevailing needs to malnutrition,
lack of enough food, lack of money, lack of enough fertile land for cultivation, corruption in
majority of public institutions, deficiency of participatory democracy and finally poor communal
organisation and actions by people. (Narayanasamy, 2009)
Upon definition of the common problems and their root causes, the group would initiate
participation of all its members to give proposals of the most viable solutions. At times, the fore
mentioned was achieved through story-telling and use of role plays. Alternatively, in order to

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involve a wider audience, ‘campesino theatres’ would be staged publicly. Once the majority
agreed that the timing and conditions present were right, development of strategy for action
commenced. Initial actions that took place were actions in defense of the rights and health of the
least disadvantaged. This occurred after they had critically assessed the conditions that they were
living in and came to a consensus that their needs were being undermined. Piaxtla health
program therefore organized actions that were related to the various ways that the ‘campesinos’
received unfair treatment, exploited and cheated by the few rich (Ruiz, 2010). Some of these
actions includes; initiating maize banks run by farmworkers, starting a cooperative fencing
program, demanding for lowering of bus fares to charges that were legal by the local bus owner,
operations by village women to shut down local public bars in attempt to curb violence and
drunkenness and, planning a protest in attempt to take charge of the local water supply from one
tycoon and transform it to a community controlled public water system.
Participants of the Piaxtla Project
Various categories of people had their participation in the program both directly and
indirectly. However, the poor families from the village of Ajoya are the key players (Brachet-
Márquez, 2014). The program was founded as a result of their deteriorating health conditions.
With passage of time and solving of the initial problems, the program shifted its attention from
delivery of primary health care to fighting for the rights of the poor families that were the main
cause of the poor health conditions. Non-governmental organizations were also participants who
played a very important role in the program. It is through such organizations that the poor
farmers were able to secure enough funding to purchase material for their projects. Such
organizations also allowed the farmers longer grace periods before they paid their dues. The
federal government of Mexico through the ministry of Agrarian reform also indirectly

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participated in the program. Were it not for them, the poor farmers would never have been able
to secure their constitutional rights nor receive land titles.
How Project Piaxtla Addressed inequity
1. Farmworkers run maize bank
The most pressing issue of inequity that the residents decided to address was the usurious
system by rich land owners loan maize. It the beginning of the planting season, majority of the
poor families had always exhausted their stores. They were usually left with no option but to
borrow maize seeds for planting in their little, unfertile pieces of land and for consumption from
the rich farmers in their neighborhood. Later on during harvest time, for each sack of maize
borrowed, a poor peasant was required to repay it as three sacks. Whenever any of them as
unable to pay, their creditors seized the poor peasants’ property inconsiderably. As a result, these
inhumane treatments pushed the poor families into states of complete destitution, untold misery
and suffering (Whiteley, et al., 2008). Some of them resulted to being enslaved by their creditors
as that was at most times the only available option.
As a way of fighting such unethical treatments, Piaxtla Project aided the small scale farmers
to come up with a maize bank in form of a cooperative. Interests charged by this cooperative
were much lower in comparison to what wealthy farmers previously charged. An additional
advantage was that all the interest collected was used in expansion of the bank’s capacity to lend.
In the long run, this loan program controlled by the community was able to spread to five more
villages. Generally, it greatly aided in the improvement of economic status of the much poorer
families. Notable improvement on the peasants’ health and nutrition was also sighted. In
addition, accountability and cooperation amongst small scale farmers was greatly fostered. Self-

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confidence was installed in people as they begun to visualize their true potential in changing
their own situation. the bank had a positive impact as several years later, it was able to reverse
the control over the community council that had been gained by several rich families.
2. Cooperative Fencing Program
The rich families had developed a habit of letting their cattle roam into the peasants’
mountainside maize fields. As a result, poor peasants always had little or no produce to harvest
(Packard, 2016). Majority of the poor farmers residing on the steep hillsides planted by slash and
burn method. Each new year for them meant clearing a new patch of land that had to be fenced to
keep the rich men’s cows from grazing into it. Due to lack of resources to purchase fencing
material, the only resolution was to borrow from the rich exploitive men. In return, they were to
grant rights to graze to the rich men to the portions they had previously cleared.
Following deep discussions and critical analyses of the situation, with participation from all
affected individuals, the Piaxtla health team in collaboration with members of the small scale
families derived possible solution. They resolved to organizing the poor peasants who joined
hands and cooperatively fenced the entire hillside. With the entire hillside being inclusively
enclosed by the fence, all could conduct their farming activities with little disturbance of the rich
men’s large herds of cattle. Capital to purchase the required fencing materials was borrowed a
locally based non-governmental organisation. Upon completion of the project, the farmers were
able to charge the rich families for grazing rights and thus they were able to recover the money
borrowed from the non-governmental organisation and repay it back. Later on, grazing charges
earned were shared and used for individual family needs.

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3. Invasion and redistribution of large land holdings
Following success of the discussed two interventions against inequity, the poor peasants had
already acquired adequate organizational and management skills. They therefore embarked on
solving the problem that was the greatest contributor of poor health and hunger. The issue was
all about inequitable distribution of the river valley farmland which was all fertile and with cross
proximity to water source and had been occupied entirely by the rich families (Ekins, 2005).
Systematically and with enormous support from the Piaxtla health Program team, poor families
begun to cultivate after invading large land holdings owned by the rich families and which the
clearly knew that they had a constitutional right to cultivate. The repossessed land was divided
fairly amongst themselves and they later proceeded to demand for land titles (locally known as
ejidal) from the government.
The state authorities which was mainly composed of officials from the rich families posed
much problem as they were not willing to help the poor peasants acquire the land titles. The poor
farmers resolved to forming a committee that was sent to the Ministry of Agrarian reform based
in Mexico City. It was until then that the state authorities had no option but to give in and grant
the poor farmers with land titles which they were eagerly waiting to possess.
Congruency of processes and action taken in Piaxtla Program with Principles and
processes of participatory planning
The various processes and actions that were undertaken to achieve success of the Piaxtla
program had a high percentage of congruency with the principles and processes of participatory
planning as discussed henceforth. To begin with, the program included poor farmers in all its
undertakings. Its chief goal was to improve the health of the poor families, fight for their rights

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and to stop the rich families from exploiting them. The program also focused on projects that
were realistic and achievable (Dodge & Bennett, 2011). The cooperative fencing program for
example was achievable by uniting all the poor families to act as one and fence their land.
Additionally, actions taken by the program were focused on people with the primary aim of
empowering them (Paramēśvaran, 2006). By initiating the maize bank for example, the program
empowered the poor farmers in a way that they had access to cheap maize with no interference
from the rich families. The program’s actions were again comprehensive and covered all people.
All poor families were included in the plans of the programs with none having to be left out for
any reason. More notably, Project Piaxtla worked towards promotion of mutual accountability
and understanding between the government officials and the community (Narayanasamy, 2009).
This is clearly notable when they were seeking for land titles from the state authorities. The
program readily formed a committee that would represent the poor families in attempt to come to
a common understanding with the officials on how the land titles were to be allocated.
Conclusion
Though small and grass-rooted programs like Project Piaxtla are hard to evaluate, the
long term fruits borne by such projects are clearly notable. The Piaxtla Program precisely
transformed the livelihood of Sinaloa poor residents a great deal. They were able to reclaim land
that was rightfully theirs and end the unjust exploitation from the few rich families. More
importantly, the economic status of these residents greatly transformed from poor to desirable.
This program is also an evident demonstration of the participatory planning approach. All the
poor families were given equal chances to participate in decision making and development
projects.

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References
Blumenthal, D. S. & DiClemente, R. J., 2013. Community-Based Participatory Health Research,
Second Edition: Issues, Methods, and Translation to Practice. 2 ed. s.l.: Springer Publishing
Company.
Brachet-Márquez, V., 2014. Contention and Inequality in Mexico, 1910–2010. illustrated ed. s.l.:
Cambridge University.
Delaney, F. M., 1977. Low-cost Rural Health Care and Health Manpower Training, Volume 3.
s.l.: International Development Research Centre.
Dodge, C. P. & Bennett, G., 2011. Changing Minds: A Guide to Facilitated Participatory
Planning. illustrated ed. s.l.: IDRC.
Ekins, P., 2005. A New World Order: Grassroots Movements for Global Change. s.l.: Routledge.
Narayanasamy, N., 2009. Participatory Rural Appraisal: Principles, Methods and Application.
s.l.: SAGE Publications Ltd.
Packard, R. M., 2016. A History of Global Health: Interventions Into the Lives of Other Peoples.
illustrated ed. s.l.: JHU Press.
Paramēśvaran, E. P., 2006. Empowering People: Insights from a Local Experiment in
Participatory Planning. s.l.: Daanish Books.
Ruiz, R. E., 2010. Mexico: Why a Few are Rich and the People Poor. s.l.: University of
California Press.

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Weil, M., Reisch, M. S. & Ohmer, M. L., 2013. The Handbook of Community Practice.
illustrated ed. s.l.: SAGE.
Whiteley, J. M., Ingram, H. M. & Perry, R. W., 2008. Water, place, and equity. illustrated ed.
s.l.: MIT Press.