The Health Program in Rural Western Mexico
Question:
Critically analyse the project piaxtla from a participatory planning approach to health and development.
Project Piaxtla is a primary health care program in the rural areas of western Mexico that was managed completely by the local villagers. Piaxtla was initiated in 1965 for serving a rugged, large and sparsely populated area located in the Sinaloa state. It was located in the foothill region of the mountain range of Sierra Madre and was named after a river flowing nearby. The area had only footpaths and traversed by the trails of the mule. Based on the largest village of Piaxtla named Ajoya, David Werner had a specific interest in the project as he was involved in it as a facilitator and advisor (Werner and Sanders 1997).
The program was initiated with the focus on curative care as that was the need of the people. Diseases used to relapse even after treatment and therefore, the health workers had to search for preventive measures and get the vaccines for cure and prevention. The introductory steps for the program were vaccination systems, latrines, water systems and safe birth control options. These preventive measures aided to improve the health of the local community but the problem of child death persisted. It was noticed that the primary reason for the death of the children was under-nutrition and the source of the problem was the land tenure system (Edwards et al. 2011). This affected the economic base of the poor villagers and degraded their lives through the political and social factors that have been discussed extensively by the authors in the book ‘Questioning the Solution’. The present assignment will critically analyse the participatory planning approach to the health and development of Project Piaxtla.
Needs assessment in the project was done in three phases. The earliest phase of the project was based on the curative care of the villagers as it was the immediate need. The health promoters of the village were given the training by the methods of learning by doing and participatory. This made them competent in the treatment of the injuries and common illnesses. However, with the progress of time, it was realized by the villagers and the health team that the injuries and illness kept on recurring (Werner 2014). Therefore, the new need assessed was to focus the project on promotive and preventive measures that included water systems, latrines and immunizations. There was a significant improvement in the health of the people and the illnesses stopped recurring. Even after a substantial improvement in the health of the people, it was found that children were dying of whooping cough and tetanus and the complications of measles and disability due to polio were persisting. The mortality rate was significantly high for the children who were below five years of age and belonged to the families who were poor, landless and underpaid (Lee, Bini Litwin and Harada 2012). Therefore, the project assessed another need and it was focused on the organized need for defending the basic rights and needs of the people. Thus, with the progress of the program, the changes over time shifted the needs from curative care to the sociopolitical action, keeping in touch with the promotive and preventive measures.
Assessing the Needs of the Villagers
It can be said that the assessment of need changed with the course of time as the program focused from the conventional measures of health to the organized action, as the villagers with changing times needed it. It was the result of problem solving, discovery based and learner centre based approach towards health education (Werner 1987). Workshops were established where the health workers started with community diagnosis and situational analysis. Initially, the program served only to meet the health needs of the people but with the changing times, the focus shifted towards improving the lives of the people as it would invariably improve the health of the people. The workshops included the health promoters along with the mothers, farmers and the schoolchildren as participants where they discussed the health related problems after their identification to get over them (Baum 2007). This gave their thinking an analytical edge and they started to look at the problems from different perspectives. This significantly helped them to identify the needs and assess them for solving the health problems and as the newer problems were surfaced, newer needs were developed with the changing times. Using theory as the framework for the analysis of the change of needs over the time, it can be argued that the links of the needs were related to the political, economic, cultural, physical and biological factors and had an impact from the beliefs and customs, power and money rather than focusing only on health. All these factors culminated to develop the healthcare needs of the poor and needy villagers that the project focused to provide them with a healthy community rather than curative care.
The program was initiated with the purpose of curative care, where the health promoters established workshops and the participants were the mothers, schoolchildren and the farmers. However, the needs changed over time and the focus of the program was changed to the sociopolitical action. The real transformation of the program started with the addressing of the issues that the poor Campesinos faced, who were the farmers (Cairncross, Peries and Cutts 1997). The Piaxtla health program formed groups that included the health team and the farmers as the participants. The first step taken towards the exploitation of the poor farmers is the formation of the cooperative based maize bank. The loan program that was community controlled helped to improve the financial position of the poor families with respect to the health and nutrition. The fencing program of the cooperative was the next step taken by the team for improving the economic base of the poor farmers by setting up a fence to prevent the cattle of the rich farmers to enter the maize fields of the poor farmers and eat up their crops (Carpenter 2000). The participation was shared again between the healthcare team and the farmers. The health team of Piaxtla along with the organization of the small farmers participated in the program and explored the possible solution. In all the operations of the Piaxtla project, it was the health team and the farmers, who were the main participants.
Shifting the Focus to Sociopolitical Action
Participation is the concept that encompasses the fundamental concepts of relevance to the aspects of life. It is the process of doing things together and achieves the goals with proper participation. Health, along with well-being, constructs the dimensions of life. It results from the participation and complex interplay of the various groups of the society from different sectors and levels. Participation is the critical tool for achieving the governmental and societal approaches to health (Stockdale et al. 2015). The collaboration of the different governance levels and involvement of the civil societies plays a major role in the implementation of the decisions of health and well-being, towards better understanding. It is a fundamental element for granting the solidity to the process of policymaking (Minkler 2012). Since the Government of Mexico did nothing for improving the health and wellness of the poor farmers. Therefore, the health team of Piaxtla came forward and collaborated with the farmers to participate in the socio-economical development of the poor farmers.
The women were not expected to participate in the program. However, the women of Ajoya and the other surrounding villages participated in the program as well. They united against the drunkenness of the men and solve the problem of alcohol abuse by the men. It has been a major cause of the domestic and interpersonal violence with children and women being the victim of it. Men often spent their income on alcohol that directly affected the health of the children and women with reduced amount of food (Werner 1995). Therefore, the women united along with the health teams of Piaxtla to eliminate the drinking habits of men and participated in the project unexpectedly.
The constitution of Mexico had the programs of land reforms for preventing the return of the process of huge plantations. Sufficient limits were placed on the legal permissions for property holdings. The system of Ejido was set up to protect equity by dividing the local farmland among the poor families (To 2003). The families could utilize their share of land and earn the benefits according to their production. The ultimate ownership, however, stayed with the ejido, that was set with the collaboration of several villages. This system protected the small and poor farmers from losing their land due to unpaid debts.
North American Free Trade Agreement (NAFTA) was the source of inequity with its neo-liberal agenda. The Mexican government, due to the pressure from the NAFTA, for eliminating the reform statutes of progressive lands. The ejido system was regarded as a barrier to the process of free trade and commerce. US agribusiness aimed at buying the Mexican tracts for growing and exporting winter vegetables (Werner 1992). This led to the dismantlement of the ejido system and the land holding sizes were repealed, with the return of the era of giant plantations.
Because of the coalition between the Mexican and the US government, the Mexican lands got concentrated into fewer hands and innumerable poor farmers were made landless and were forced to relocate in the slums of the cities and add to the growing list of unemployment. These developed and inequity between the rich farmers and the poor peasants where the former started to multiply their wealth and the poor were forced to leave the village in search of food. This inequity severely hit the health of the poor Mexicans as the wages went down and it became harder for the families for feeding themselves that resulted in under-nutrition and eventually, death (Fowkes and Tarimo 1989). Although NAFTA was initially regarded as the progressive step towards the national prosperity and growth of the economy, however, it landed up in devastating environmental and human costs. Along with these severe outputs of NAFTA, another issue that rose out of the devastation was AIDS. Out of hunger, joblessness and landlessness, people insisted on carrying out sex trade that resulted in an increase in AIDS patients in Mexico (Koch 1979). The inequity planted by NAFTA resulted in a majority eradication of the poor peasants from their lands and made them helpless, with degraded conditions of health and frequent deaths.
Using a Participatory Planning Approach to Tackle Health-Related Issues
To address these issues of inequity, a network of health programs that was community-based from the Central American countries and Mexico interchanged their ideas to analyze their miserable situation of inequity and address the health issues (Werner and Coen 1978). They exchanged strategies to help their countries to place their respective communities towards the living situations that are free from NAFTA and are more equitable. Peasant uprising in the Chiapas was the most significant step towards addressing the inequity. The ejido system was re-discussed and government loans were proposed. The Project Piaxtla outreached efforts to make the peasants realize the importance of ejido so that they can retain their rights of their lands and maintain their good health and well-being (Harbridge 1998).
Participatory planning is the paradigm of rural or urban planning which emphasises on the involvement of the communities in the management and strategic processes of urban or rural planning. It is the part of the development of the community and aims to harmonize the views among the participants of the planning process and prevents the possible conflicts between the parties that are opposing. Marginalized groups participate in the process of planning and develop a structure for allowing meaningful and natural inputs from all the citizens. It facilitates the investigation, learning, presentation and analysis by the local people and helps to generate the outcomes from learning (Kangas et al. 2015). The facilitators critically and continuously examine their behavior. For the sustainable development of the community, participatory planning is the method for the democratization of the research, decision-making and planning. It attempts to manage growth effectively and design a plan for the future that will prevent compromising by the future generations for their quality of life. The decisions regarding the future development and growth management are quite complex and are embedded in the dynamics of the environmental, political, economic and social systems. Within the communities, the complexities of perceptions and values and the powers of the various groups of the stakeholders affects these decisions and are widely assumed by the participatory planning (Menzel and Buchecker 2013).
In context to the project Piaxtla, the ratification of NAFTA gave a devastating blow to the farmworkers organization and Project Piaxtla. The poor farmers faced the danger of losing their land and health. The insurrection of the Chiapas helped the farmworkers and the health team of Piaxtla to conglomerate in Sinaloa to regain their lost health and land. This was an exhibition of participatory planning where the Mexican peasants got together to fight for their future and was marked significantly by the Zapatista uprising (Stark 1985). Due to this agitation, President Salinas agreed to reinstate partly the ejido system and the land reforms. According to the principles of participatory planning, marginal groups participate in the process of planning and develop a structure for allowing meaningful and natural inputs from all the citizens. This was clearly seen from the constant struggle by strategic planning by the farmworkers and the health activists for the healthier future of the children of Piaxtla.
Soon after the victory of the Campesinos and the health promoters, they relieved that the rights to their lands have been preserved and they can have the ownership. This was critical as this can give them the much-required freedom from hunger and lead to better health. The villagers realized that the future has been lesser insecure that ever. Community struggle and organizing gave them this much-needed improvement in health. All this was possible only through the process of participatory planning. Even the US citizens contributed in the planning as they joined forces along with the workers of Mexico and worked with them, rather being divided. NAFTA produced unemployment in the US and sufficient turmoil was created in the US as well. Therefore, the only way to secure the future was that the Mexicans and the Americans join hands and fight out the real reason of their misery through participatory planning (Lauffer 1979).
Long term social change was the ultimate health determinant of Project Piaxtla and its contribution was meagre considering its grassroots level efforts towards the future of Mexican health and lifestyle. However, the local effect was tremendous by the health activists and the farmworkers organization and promoted empowerment among the poor farmers. A 20% decline in the rate of child mortality was observed in contrast to the rate at the initial stages of the program. Although there was a decline in the wages of the employees, extreme poverty was controlled and the gap was narrowed substantially between the poor and the rich in terms of distribution of power, wealth and land. The villagers elected for the conservation of their ejido status further fortified their gains in terms of health and land. Several hindrances and blocks were placed in the path of the Project Piaxtla as the government attempted to stop the program on many occasions. The project participants along with the farmers have been threatened and jailed. The government to shut down the business of the project also initiated alternative health services. However, these could not stop the project from achieving its goals and the team focused on the aspects of basic political, economic and social reasons for poor health conditions. Overall, the team worked efficiently to improve the quality of life of the poor farmers and reduce the rate of child mortality, which is much more significant than a narrow medical approach.
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