Analysis of Project Piaxtla Using a Participatory Planning Approach

This is a critical analysis of Project Piaxtla from a participatory planning approach to health and development: It is a reflection on Chapter 19 in Werner and Sanders’ “Questioning the Solution


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 derived its name from a river in the nearby foothills of the 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, the largest village covered by Piaxtla. Since it was incepted, David Werner has shown intensified involvement in the program’s affairs as its advisor and facilitator (Packard, 2016). In its initial stages, it was dominated by diseases of poverty, mainly chronic undernutrition, and diarrhea. It had also been observed that out of three children, one died before age 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 childbirth. These conditions brought about untold social injustices and inequity (Ekins, 2005), as discussed later.

Assessment of needs and changes over time in need assessments.

Participatory planning involves the definition, proposals, and enforcement of management plans based on issues 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 affecting a larger section of the community. Participatory approach theory, therefore, derives its main concerns from issues that affect the majority in the area of study (Blumenthal & DiClemente, 2013) and seeks to develop various models that will help resolve the problems identified.

Various approaches were adopted in assessing the needs that prevailed over time in the Piaxtla project. However, the needs identified at one particular time were not constant throughout, as once resolved, new categories of needs came up, and the managerial team needed to divert their attention to them. To begin with, the prevailing and deteriorating health situation in Sinaloa, as previously reflected by the project’s initial findings, brought about the inequitable and unfair distribution of wealth, land, and power (Brachet-Márquez, 2014). Most poor families located in the rural areas and locally referred to as campesino had little or no land to call their 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 could access quality healthcare anytime they needed it. It, therefore, goes without saying that most residents were being denied their constitutional rights and basic needs. Whenever they attempted to organize themselves and demand what was rightfully theirs, the few rich families completely blocked their attempts as they had complete control over the community council of Ajoya.

Strategies aimed at improving the health status by Project Piaxtla assessed the prevailing needs and evolved in three phases. The earliest phase had little concern for political agenda and was therefore concerned with the improvement of curative care as well as preventive care. Local health promoters in the village were educated and trained through participatory approaches and ‘learning by doing’ methods, which greatly improved their competency in treating common injuries and illnesses. The 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; dehydration, gut infection, diarrhea, contamination through fecal matter, shortages of latrines, and no supply to clean drinking water. As the initial move gradually eradicated the prevailing needs, the program’s focus on the other hand gradually shifted to promotive and preventive measures. Such measures included the provision of latrines and water systems and the initiation of vaccination moves. The second phase was also productive as various illnesses that were initially common in the locality faded away, and there was a notable improvement in the overall health of the residents. Minimizing tetanus, whooping cough, polio, and measles, identified as the primary need of the project’s second phase, was actualized.

However, the number of malnourished children and women remained high and more so in the years when the harvests were poor (Ruiz, 2010). Mortality rates of children below five years were still skyrocketing among children thriving from families with poor backgrounds. Most of these families remained landless, received poor wages, and were exploited by the few rich in many ways. These conditions, therefore, resulted in a 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 approaches to solving problems in health education. In the third phase, therefore, the 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 the 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 the participation of all its members to give proposals of the most viable solutions. At times, the fore mentioned was achieved through story-telling, and the use of role plays. Alternatively, ‘campesino theatres’ would be staged publicly to involve a wider audience. Once the majority agreed that the timing and conditions were right, developing a 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 their living conditions and came to a consensus that their needs were being undermined. Therefore, the Piaxtla health program organized actions related to how the ‘campesinos’ received unfair treatment, exploited, and cheated by the few rich (Ruiz, 2010). Some of these actions include; 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, and operations by village women to shut down local public bars in an attempt to curb violence and drunkenness and, planning a protest in an 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 the passage of time and solving the initial problems, the program shifted its attention from delivering 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. Poor farmers could secure enough funding through such organizations to purchase materials 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 participated in the program. Were it not for them, the poor farmers would never have been able to secure their constitutional rights or receive land titles.

How Project Piaxtla Addressed Inequity

  1. Farmworkers run maize banks.

The most pressing issue of inequity that the residents decided to address was the usurious system by which rich landowners loaned maize. At the beginning of the planting season, most poor families had always exhausted their stores. They usually had 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 they could not pay, their creditors seized the poor peasants’ property inconsiderably. As a result, these inhumane treatments pushed poor families into destitution, untold misery, and suffering (Whiteley et al., 2008). Some of them were enslaved by their creditors as that was, at most times, the only available option.

To fight such unethical treatments, Piaxtla Project aided the small-scale farmers in developing a maize bank as 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 expanded the bank’s lending capacity. In the long run, this loan program, controlled by the community, spread to five more villages. Generally, it greatly aided in the improvement of the economic status of much poorer families. A notable improvement in the peasants’ health and nutrition was also sighted. In addition, accountability and cooperation amongst small-scale farmers were greatly fostered. Self-confidence was installed in people as they began to visualize their true potential in changing their situation. Several years later, the bank had a positive impact; it could reverse the control over the community council that several rich families had gained.

  1. Cooperative Fencing Program

The rich families habitually let their cattle roam into the peasants’ mountainside maize fields. As a result, poor peasants always had little or no produce to harvest (Packard, 2016). Most poor farmers reside 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 a 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 in 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 derived a possible solution in collaboration with members of the small-scale families. They resolved to organize the poor peasants who joined hands and cooperatively fenced the entire hillside. With the entire hillside inclusively enclosed by the fence, all could conduct their farming activities with little disturbance from the rich men’s large herds of cattle. Capital to purchase the required fencing materials were borrowed from a locally based non-governmental organisation. Upon completion of the project, the farmers could charge the rich families for grazing rights. Thus, they could recover and repay the money borrowed from the non-governmental organisation. Later, grazing charges earned were shared and used for individual family needs.

  1. Invasion and redistribution of large land holdings

Following the success of the two interventions discussed 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 to poor health and hunger. The issue was all about inequitable distribution of the river valley farmland, which was all fertile and cross proximity to water sources and had been occupied entirely by rich families (Ekins, 2005). Systematically and with enormous support from the Piaxtla Health Program team, poor families began cultivating after invading large land holdings owned by rich families, knowing they had a constitutional right to cultivate. The repossessed land was divided fairly amongst themselves, and they later proceeded to demand land titles (locally known as ejidal) from the government.

The state authorities, mainly composed of officials from rich families, posed many problems as they were unwilling to help the poor peasants acquire land titles. The poor farmers resolved to form a committee sent to the Ministry of Agrarian Reform based in Mexico City. Until then, the state authorities had no option but to give in and grant the poor farmers with land titles that they were eagerly waiting to possess.

Congruency of processes and actions taken in the Piaxtla Program with Principles and processes of participatory planning

The various processes and actions undertaken to achieve the 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 poor families, fight for their rights, and to stop rich families from exploiting them. The program also focused on realistic and achievable projects (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 promoted mutual accountability and understanding between government officials and the community (Narayanasamy, 2009). This was notable when they were seeking land titles from the state authorities. The program readily formed a committee representing poor families to come to a common understanding with the officials on how the land titles were allocated.


Though small and grass-rooted programs like Project Piaxtla are hard to evaluate, the long-term fruits borne by such projects are notable. The Piaxtla Program greatly transformed the livelihood of Sinaloa’s poor residents. They could reclaim their land rightfully and end the unjust exploitation of 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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