Background

Discuss about the Primary Healthcare And Strength.

The current study focuses upon the aspect of primary healthcare and strengthening some of its resources for providing improved care and support services to the rural and the marginalised people. It has been found that most of the times the people living in the poor and downtrodden sections are deprived of the basic health and support care services as most of the healthcare workers do not feel like visiting those areas due to the lack of effective transport or connectivity. Additionally, the socio cultural as well as the language differences also create barriers to the equal distribution of the health and support care services. It has been found that some of the people living in the poor or the marginalised areas come from indigenous background and communicate in an altogether different language.

The language difference can further create the differences in the quality of the support and healthcare services delivered. Additionally, the lack of medical interpreters in most of the regions makes receiving the healthcare services further difficult for the patients. Therefore, the development of the primary healthcare practices can re-enforce rural health development. This is further dependent upon the steps taken by the Government which are aimed towards providing maximum healthcare resources to the rural population or the underprivileged section at cost effective prices. 

The PROJECT PIAXTLA is rural primary health care program operational in Western Mexico. It was named after a nearby river and located at the foothills of the Sierra Madre Mountain Range. Piaxtla was started to serve the largely populated sated of Sinaola in the 1960s. The program was started in Ajoya village which was one of the largest villages within the Piaxtla area of coverage. David Werner has been involved with the program as a facilitator and an advisor. The project Piaxtla was developed on the guidelines of making the residents of the village self sufficient by providing them as well as educating them about health care methods and approaches. However, the economic crisis in the 1990s as an aftermath of the North American Free Trade Agreement (NAFTA) created a huge bridge between the rich and the poor. It further resulted in discrepancies within the health and support care services. The economic crisis accompanied by civil disharmony within the Ajoya village where thefts, assaults and murders were common   on a day – to – day basis made survival difficult over there. As mentioned by Hall  et al. (2017), the civil disharmony made many people fled from the village of Ajoya and the  surrounding regions due  which the project Piaxtla almost came to a dead end. As argued by Hopwood (2015), there has been recent rise in activities such as drugging and trafficking of drug,  which made the region unsafe for  people to exist, as a result many people  left the region.

Analysing the Project Piaxtla from a participatory planning approach

There has been a gradual evolution in the strategies of Piaxtla from curative care to social action. Here, the improvement in health was brought about in three phases. In the earliest stage, it had no political agenda and only focussed upon providing immediate cure to the people. The village health advocates were trained using participatory learning approaches. By the end of these programs they grew sufficiently competent in dealing with the common illness and injuries (Hall et al. 2017). However, a gradual recurrence pattern was seen in the illnesses. Therefore, the goal was to shift from curative mode of care to preventive mode of care. Here, the main focus was given on improving the water  and sanitation  systems, as it was found that most of the villagers  did not use proper sanitation techniques  as well as  they did not have  proper access to safe  and clean  drinking water. Due to the success of the program the under five mortality rate in children due to common illnesses such as measles, whooping cough, polio was reduced by drastic rates. However , the problem  persisted in a  certain  section of the poor children without  proper  home  and  family and were  often  taken advantage  of by the wealthy section of the society. Therefore, the goal of the program was changed from preventive and primitive measure to organized action. The shift in the focus of the program from conventional health measures to organized action was a result of learner centred, problem-solving and discovery based approach to health education.

Discussion of participatory planning approach

The project Piaxtla  was based upon a  participatory planning  approach  where  the health  advocates were chosen from local villagers and were assigned  the tasks of learning about  healthcare and  disseminating them equally between the  villagers.  As mentioned by Herrett  et al. (2015), the health advocates were made part of the local and community healthcare where they were given training on management and training of the common health issues such as fever , cold, cough. The learning was further disseminated through handbooks consisting of the specific guidelines to be followed for effective delivery of health and support care services.

One of the most important attributes which had been highlighted in the guidebook was the vaccination protocols and the procedures. The village health administrators were given the responsibility of educating the population on the importance and affectivity of vaccination. The handbook of the villagers read, “Where there is no doctor”.  The entire program was structured at empowering the rural people. As argued by Lawless  et al. (2014), the program was entirely directed by the local villagers. Hence, there were less chances of disagreement by the people of region as they were reporting to or following the instructions of the ones they had already known. The participatory planning approach lead to inclusion of more and more village health workers at each step of the project, as the ones who were already trained in the methods of primary healthcare delivery would in turn train a few more.

Rural inclusion and empowerment though Project Piaxtla

The project Piaxtla further gave rise to a sister project known as PROJIMO.  It was run for and by the people with disabilities, which further helped in the empowerment of the disabled people. Additionally, the involvement of the disabled people as mentors in running the project further helped in deciphering the needs and requirements of the one with similar disadvantages (Ball et al. 2017).

The project Piaxtla helped in supporting rural empowerment by advocating their health causes. Additionally, training the villagers on management of various health issues could help in doing away with the myth and cultural paradoxes attached with the management of ill health. As mentioned by Munyewende  et al. (2014), the health attitudes and health behaviour of a person are often associated with different faith and cultural attitudes. Therefore, educating a single villager upon management of health issues can help in training few more on health and awareness.

Additionally, the project Piaxtla has taken important issues into consideration such as sanitation and water issues. As mentioned by Wakerman (2018), spreading awareness regarding proper sanitation can control and check the spread of the communicable diseases.  Recently the growth in the drug trafficking activities has lead to a partial pause in the project. As commented by Powell Davies et al.  (2017), the revival of the project Piaxtla  could help in removing the  health discrepancies brought about by various activities such as thefts and murders,  which promote civil disharmony. One of the most significant issues, which were faced in this regard were the unequal distribution of power between the rich and the poor. Before implementation of the Piaxtla project the villagers had been subjected to huge oppression by the richer section of the society. Additionally, the implementation of the program empowered the village women to reduce the incidences of drunkenness and violence by closing the local beer shops. They were supported by the local community healthcare leaders which guaranteed further success of the program. Through the project the control of the village water systems from the local wealthy men were taken and a public water system was introduced which was aimed towards making the community stronger. One of the most significant initiatives in this regard was the cooperative maize bank.  Under this, the farmers and the local health workers managed to get a part of the river bottom land. The cooperative corn bank provided the local villagers with corn at very low interest compared to the huge 300% interest charged by the land owners (Edington, 2017).

The project Piaxtla helped the local villagers overcome poverty and poor health. The project helped cope up with the drastic figures such as 34% of the children died in the first five years of their life owing to common health issues such as diarrhoea, whooping cough, measles, etc (Fernández Velázquez 2016). It was found that under the corrupt land authorities that the rich kept on increasing their share of land. As mentioned by Craig  et al. (2016), the implementation of the project made people more aware of the curative self care. Additionally, taking the project on serious basis made people realize that some of the illnesses occurred in a repetitive manner. The  program helped  in  shifting towards more preventive  measures  such as providing  the children with  vaccination programs , focussing more upon sanitation and  water systems.  Some of this measure was effective in improving the overall health condition of the women and the children in that region. It was seen that the women often suffered   sexual health issues s owing to improper sanitation. However as argued by Scrinis  et al. (2014), the success of the measures implemented were dependent upon the success of the harvests. It was found that the preventive measures were really low on implementation the year in which poor quantity harvest were yield, as the returns on investment were not sufficient to support the sanitation and the safe drinking water projects.

Initially, the villagers were charged interest equivalent to 300% for sharing maize from the land owned by the rich. Additionally, the poor farmer very soon used to run out of their storage of maize. For every sack of maize borrowed from the rich land owners they were supposed to return 3 sacks (Marquez-Berber et al. 2015). In case, the poor farmers were not able to pay back to the rich land owners on time they would be reaped of most of their possessions.  In most critical scenario, some of these villagers will have to sell off their land to repay the loans and settle in slums (Chisholm 2016). Hence, the villagers started cultivating their own maize which was available at 25% interest rates (Ortega 2015). Additionally, the surplus profits earned from the harvest   helped in improving the economy and nutrition of the people of the region.

Out of the wake  of the  piaxtla project the  health workers  helped the local  women organize  protests  which   prevented the opening of the bars as it was found that  drinking alcohol served as one of the  contributory   factors for the violence in the region. However, there were a number of limitations of the project with regards to the safety of the health workers. The health workers who had gone interest of the local land owners were often threatened or jailed. As mentioned by Rojo (2014), the growing repression may affect the motto of the villagers to provide and accommodate for healthcare services in the lack of doctors or physicians. Additionally, the introduction of one after the government programs had made the project redundant. The rich continued to bribe the police or the local municipality staff which ensured that some of the strong voices were often suppressed. It was also found that the sister agencies which were provided with the same responsibilities would often accept bribe from the higher authorities.There was also lack on the part of the government which  started  focussing  on illicit activities  such as  drugging and made it  a separate  monitoring project rather it would have yielded better results  if it would have been made part of a single  unified project (DiAz 2014).

A number of hindrances were faced in the implementation of the project. For instance, there was lack of support from the local and the federal  level government. Additionally, the political unrest in the area such as incidences of thefts, robbery, murder etc further arrested the progression of the project. Additionally, the time to time revival of different government projects often affected the success rate of the Piaxtla project.

Some of the factors such as the fear of violence often reduced the participation limits of the local health workers. In the lack of participation the required rate of positive health outcomes could not be matched. Moreover, some of the measures   implemented as part of the project such as sanitation and waste water management were completely dependent upon the returns from the maize harvest. It had been seldom noted that in the lack of sufficient crop harvest, the health community workers often failed to meet the healthcare needs and requirements of the local people. There was also insufficient help and support from the government both at the local and at the federal level. This is because the rich would often bribe the local inspection officers through corrupt means, as a result of which strict action would be taken against the healthcare workers, which further checked the progression of the activities.

Conclusion

The current study focuses upon the concept of primary health care practice and its importance in health and development. The success rates of the primary healthcare practices were often limited due to lack of sufficient support and cooperation from the local and federal level government. In the current study, a specific project has been taken into consideration which is the Piaxtla project.  The project aimed to facilitate care in the lack of doctors and trained healthcare professionals. This was done by giving the villagers training on self management of health conditions. It helped to reduce the health inequalities by educating the villagers on the importance of vaccination programs, effective sanitation and water systems. However, the political unrest in the area led to a situation where most of the villagers had to leave the area on account of safety issues. This challenged the success rate of the project as the villagers were dispersed and were few people were actually left for support of the project.

However, several positive results were yielded from the study such as the mortality rates of children below the age of five years were reduced. Additionally, the health rates of the women and childen improved considerably. The empowerment of the local healthcare workers through sufficient education   helped in the encouragement of community wide health education along with taking actions activities which promoted violence such as drinking.

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