Aim

Discuss about the Primary Healthcare Practice in Developing Countries.

• 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

• 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

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 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.

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. 

Objectives

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.

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.

Question for Reflection

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).

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.

The Farmworkers-Run Maize Bank

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.

How needs were assessed and changes over time in needs assessment

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. 

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 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.

Who participated in the program and who may not have participated?

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 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.

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.

References

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