CHICAGO, Illinois — In Coahuila, Mexico, before the introduction of the Piso Firme program in 2000, ill health and poverty plagued the community.
Poverty and Ill Health
A significant cause of ill health is unsanitary living conditions and improper housing, such as houses with dirt floors. According to the World Bank, replacing a dirt floor with an adequate alternative, such as cement flooring, reduces the incidence of diarrheal disease and parasitic infections.
The World Health Organization (WHO) notes that diarrhea is the number one cause of malnutrition among children under 5. The communicable disease is the second most significant cause of death for children under 5, with 525,000 children dying yearly. Furthermore, children under 3 in low-income countries experience three times more incidences of diarrhea annually than children of the same age group in higher-income countries.
Yet, there are more than 1 billion people living in an environment with dirt floors and a lack of essential hygiene and sanitation services, Bloomberg noted in 2021. Children are most vulnerable to infections and diseases because they crawl on the floor and play in dirt.
Before 2000, many households in Mexico found themselves in desperate need of a low-cost but effective solution due to illnesses arising from the multitude of homes built with dirt floors.
The Launch of Piso Firme
In 2000, Enrique Martínez y Martínez, governor of the Mexican state of Coahuila, launched the Piso Firme (Solid Floor) program to replace the dirt flooring of houses with cement floors. Considering that a healthy home is an essential social determinant of health, the governor planned to provide concrete flooring for 34,000 people in the community by 2005. The government delivered cement to the community and the people installed the floorings themselves. To be eligible for the program, a household needed to have dirt floors and be of low income. Due to the program’s success, then-president Felipe Calderon replicated the program nationally across other areas in need.
Piso Firme’s Impacts in Coahuila
Maria Lopez resided in the outskirts of the state of Coahuila as a teenager and recalls the community health improvements arising from Piso Firme’s newly implemented concrete floors. In an interview with The Borgen Project, she recounted that medical care was scarce during her childhood, with only one doctor who intermittently visited and a few nuns who could offer limited help. Lopez said, “If you got sick, there was nothing much people could do other than household remedies.”
When the Piso Firme program first reached her community, Lopez remembered the difference in cleanliness between a dirt floor and a concrete floor. “When a floor is made of dirt, even if you clean it, it is [still]pure dirt” with insects crawling through the dirt. But, a concrete floor positively impacts household hygiene. “When the floor is made of concrete, cleaning becomes more effective and the house looks and feels cleaner,” Lopez says.
Lopez recalls that, after the introduction of the cement floors, children became ill less often and overall joy seemed to have increased in the community. Typically, children would miss several school days due to stomach issues and other infections. Lopez notes that Piso Firme improved the health of many households, saying “it was as if everyone were under a spell and it was suddenly lifted.”
Costs of the Program
The program’s total cost in the state of Coahuila amounted to $5.5 million or $162 per household. As part of the program, the government offered homeowners with dirt floors up to 538 square feet of concrete flooring that each owner can lay and prepare themselves in about half an hour. The program’s expansion nationally cost about $1.27 billion between 2007 and 2013, which is relatively inexpensive for a project of that magnitude within such a time frame.
The Impact and Evaluation
The World Bank evaluated the Piso Firme initiative and found a 78% decrease in parasitic infestations, an 81% drop in anemia and a 49% drop in incidents of diarrhea among children. Additionally, the World Bank found that the complete substitution of dirt floors for cement floors led to “a 59[%] increase
in self-reported satisfaction with housing [and]a 69[%]increase in self-reported satisfaction with quality of life” along with a 52% lower assessment of depression.
Similar findings from other studies reported that improved living conditions and quality of life led to the language and communication skills of children increasing by 30% and children scoring higher by 9% in vocabulary tests. Lastly, the program’s national expansion in 2005 led to Piso Firme improving the health of 300,000 more households. By 2012, Piso Firme’s concrete flooring reached 2.7 million households.
After seeing the success of Piso Firme, other middle-income countries with large slum populations also started to invest in bettering the living conditions of poor people in their lower economic regions.
Despite the success of the Piso Firme program, Lopez says, “there are still many people in Mexico who need help and… higher income governments need to be more united in supporting our poorer governments [that]may not have all of the resources to implement those solutions for the people.”
Fortunately, Piso Firme’s national expansion managed to improve the lives of millions of low-income families in Mexico. Even though Mexico’s people still suffer from several poverty-induced issues, the Piso Firme initiative is a success story, showing the capacity of social initiatives to improve living standards and reduce poverty in a country.
– Andres Valencia