The Participatory Approach in Community-Based Health Programs
Discuss about the Project Piaxtla for Evaluation and Program Planning.
Project Piaxtla was a health program in Western Mexico since it was community-based. The project served over 100 villages in the area, and the local people run it. The founder of the project, David Werner was also the main advisor. He founded the project in the year 1964, and he was its main facilitator.
A participatory planning approach is used in communities to learn and engage with the people. This approach ensures that the community is involved in the planning process as well as the management. The primary aim of the participatory approach is to ensure there is harmony in the views given by members of the community and that there is no conflict when the views are not consistent.
It was a community-based project in Western Mexico and helped over 100 villages. The project was a health-based programme and sought to solve the issues of health that exist among the local villagers (Rojo 2014). The project was located in the Sierra Madre Mountains, and it was named after a local river that runs nearby. Local villagers entirely ran it.
The project was based in Ajoya which was the village with the largest population at that time. The village, however, went through tough times in the mid 90’s. This was as a result of the North American Free Trade Agreement that caused a wide gap between the rich and the poor in the country. This is because more people were out of jobs and the wages were falling. This caused an increase in crime and violence in the country (Scrinis et al. 2015). Ajoya was significantly affected as it was and still is a strategic location for illegal drugs exchange as they are grown in the mountains. Due to this, the place faced a lot of robberies and attacks that caused people to flee the area.
This led to the demise of Project Piaxtla as there was too much violence for it to continue running. The people that still remain in Ajoya are not able to receive any health care programmes as well.
When Project Piaxtle started in 1965, Mexico was ridden with poverty which caused many diseases as well. This was known as diseases of poverty. At that time a lot of children were dying due to diseases such as diarrhea and other diseases, and this was mainly caused by undernutrition (Wallerstein et al. 2015). Since they did not have money, they were not able to eat enough too, and this caused many health problems. The women were also, and a lot of them died during childbirth as a result of being anemic.
Challenges Faced by Project Piaxtla
All this was caused by the inequity that existed in the country. The land, power and wealth distribution in the country was not equal as the poor people owned very little with the rich scooping the more significant share. All these contributed to health problems that people in Ajuya faced and hence the development of the Project Piaxtle (Van de Sande and Schwartz 2017).
As mentioned earlier the participatory approach seeks to involve the community by learning and engaging with them. The approach is used in projects to identify the needs, to plan and monitor them to ensure that they are fulfilling what they were set out to. It seeks to ensure that the community in which the project is being implemented actively participates in the issues that it is facing (Lovan, Murray and Shaffer 2017). This is by providing interventions and solutions to the project. The participatory approach combines findings and analyses which gives the community members opportunities to act on the data that is uncovered.
The participatory approach has been used by rural communities in the developing world in bettering their villages. The approach has been found to be the most effective in these areas. This is because the rural poor can share ideas on the issues that affect them and how they can solve them (Eldredge et al. 2016). They are the ones who can tap into their communities and give an accurate finding as that is the reality that they live in every day.
The local people can share their perspectives so that they can create program or projects that can help them. The participatory approach can be used to monitor and evaluate the Project Piaxtla.
Project Piaxtla focused on solving the health problems that existed in Western Mexico however it had issues that conflicted with its primary goal. The issues are as follows:
When the project first started in the year 1965, Western Mexico was faced with a lot of diseases mainly caused by poverty. A lot of the children were dying due to these diseases and mothers were also dying during childbirth. This is because most of the mothers had anemia (Busse, Aboneh and Tefera 2014). David Werner was able to assess the needs of the people in the village through involvement with the community members. This is a principle in participatory approach where the community is involved in the planning process by sharing and learning knowledge from them.
Utilizing the Participatory Approach for Needs Assessment
After assessing the villagers wanted the curative care. This is because many people were sick at the time and many of the villagers wanted to be cured first before thinking of how to prevent the diseases. The health promoters were trained using the participatory method to assess the needs of the villagers. They were trained in learning, where they learned about the health situation in the villagers.
However, the curative care treatment did not last long as the diseases that they kept treating kept on recurring. The village health promoters had to shift their treatment to preventive measures. This they also did using the participatory approach as they assessed the needs of the people which were not met as the people still were being ridden by the same diseases (Werner 2014). The preventative measures allowed for people to get vaccines and during this phase, diseases became less common.
The project ensured immunization for all as well as the building of latrines and water systems. This was with the help of the community in identifying the areas they thought caused the recurring of diseases. However, after this changed children continued to fall ill due to malnutrition. The project failed to cater to their needs of poverty (Unertl et al. 2015). This was especially rampant in seasons that the harvest was not good. Since the poor had little land, they could not plant that much food, and therefore they did not have much to live with. The project in this instance was not able to assess all the needs of the villagers which are against the practices of the participatory approach that encourages participation of the community.
The project had to change its main focus so that they can be able to meet the needs of the community that they had identified. They changed to organized action where the project aimed at defending the rights and needs of the people (Edington 2017). In this phase, the project had become political which it was not at first. In this instant, the project had utilized the participatory approach by being able to incorporate different perspectives in the project.
At first, it had only focused on one perspective, and that was curing, but later it was able to include the political perspective which would still help in solving the health problems in the community. This change in the programmes was due to the participatory approach that involved learning, discovering and identifying problems.
Community Involvement in Project Piaxtla
Workshops were held by the health promoters that involved mothers, children, and farmers. In these workshops, the participants were able to identify their needs or issues and how they relate to their health. Instead of finding out an issue they were able to give instances that lead to the issue. For instance, if a child was ill then what were the cases that led them to be sick? From the above, we can say the needs assessment utilized the participatory principles and practices (Wright, Williams and Wilkinson 1998).
When Project Piaxtla was founded, the primary aim was to solve the health-related problems that faced the people of Western Mexico. For the project to accomplish this, it had to involve the community members in learning and identifying the needs of the people. In this case, it utilized the participatory practice that encourages the involvement of the villagers.
The people that were involved in the program were the village health promoters, farmers, women, and children. The village health promoters went through training where they were able to learn about the community. They organized workshops as well for the members of the community, to get different perspectives of the villagers which is an essential practice in the participatory approach.
The participants were also able to work together in teams to accomplish a practical task which is also a principle in participatory planning. The health promoters worked together with the community members to ensure that the basic rights and needs of the people were met. When looking at the situations that caused the diseases, the health promoters and community members looked for ways to break the links to the diseases. They started with the easier links that had fewer risks and less violence such as those at the community level.
They later came to realize that an action to bring inequity to the poor caused negative responses from the people that were in power. Some of the actions that this teamwork was able to come up with are:
- They demanded that the local bus lower its bus rates which were to be done by the owner
- They started a maize bank to help during the low harvests
- The village women organized themselves to shut down the local bar with an aim to reduce drunkenness as well as violence.
- They organized a protest to gain the control of the water system from a wealthy man.
From these instances, we see that the persons in the society that were rich were not involved in the project as they were not faced with the issues that the people in the local villages were faced with. Therefore they could not provide any necessary input that could be used.
A lot of the villagers living in Western Australia were poor, and they owned very little land. The gap that existed between the rich and the poor was vast with the rich owning most of the land, wealth as well as having the most power. The distribution was not equal. The fertile lands were held by the wealthy while the peasants owned the infertile lands.
Addressing Inequity in Western Mexico
The villagers had the options to farm on the mountainsides which produced minimal yield or plant in the farms of the rich and handover half their harvest. In both scenarios, the return was still not enough given the hard work and effort put into it. Therefore, the food would not last the season and the children would eventually go hungry.
The ejido system was eventually formed that allowed poor farmers to own land through the equitable distribution of farmland. At this stage, the farmers had gained a lot of skills through the learning and sharing in the participatory approaches in the earlier stages. With this new confidence, they were able to demand ejidal land titles after cultivating on the lands that the large family owns. This is a principle in the participatory approach as it aims in the end, that the community will be able to be given analysis and findings that they will use to solve their problems.
The farmers, in this case, knew how to solve their problem of inequity in the distribution of land, and they had found the right time to do so. With their persistence, the farmers were able to get land that they would cultivate on and ultimately have food to last them the whole season. This had a great impact on the children as their health improved and they fell sick less often (Nading 2014). The farmers thanked the Project Piaxtla for this and said that the ‘operative action’ helped them a lot.
In this instance, we see that the project was able to ensure equity in the distribution of land in western Mexico and this helped them in achieving their primary goals which were to solve health problems in the area (de Andrade et al. 2015). They were able to accomplish this using the participatory approach as the farmers were able to identify the problems that they had and form solutions in solving them.
Yes, they were. When Project Piaxtla was first founded in 1964, it addressed the immediate needs of the people in Ajuya which was curative care. In this instance, it was able to identify the needs of the local villagers through learning of the communities to help them. The project was able to provide a cure to the people.
The diseases kept recurring, and they had to create preventive measures. In this instance, they aimed at ensuring that the local people would not become sick again (Werner and Bower 1984). They involved the community in the process by allowing them to share their ideas of what was causing the diseases to recur (Berkley-Patton et al. 2015). With this information, the village health promoters were able to come up with ways such as immunization and better drainage to help.
When children were still falling sick, the project had to change its programmes again to help the community. They set up workshops that involved farmers, women, and children to get the different perspectives on why they thought the children were still getting sick. They were able to identify that it was through malnutrition which was caused by the lack of food (de Onis 2015). Through the involvement of the community, they were able to establish that all this boiled down to inequity distribution in the land.
The farmers, as well as the local villagers, were able to work together to ensure equity of distribution of land so that they would be able to farm enough food for their kids to feed them. Through the sharing and learning, the farmers were able to solve their problems.
All the above examples show how the processes of the project are in agreement with the process and principles of the participatory approach. The project was able to involve the community, identify their needs, work as a team, analyze their situations and find solutions to the problem.
Conclusion
Project Piaxtla has used the participatory approach in its processes and planning. The project was successful as it was able to identify the needs of the local people and learn and share with the community in solving their problems. The issues of inequity in the distribution of land, wealth and power, as well as the needs of the villagers in Western Mexico, were successfully met. The project was a success as it was able to accomplish its primary goal.
References
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