In today’s A Continuous Thread, I'm taking you back to one year ago, at our 2025 Artisan Leaders’ Meeting in Panajachel.

Annual Leaders’ Meetings are a space for our team and representatives of all 16 artisan groups to share news, give and receive feedback, eat and laugh together. Last August we tried something new: a working session to engage the leaders in setting priorities for the health & well-being program.

Pie charts & participatory budgeting

Since we began expanding health & well-being programming, artisans’ insights have steered our approach and priorities. In 2022, an anthropologist guided each group through a creative process to identify the factors that influence whether a woman is healthy or unwell. The insights helped determine initial project areas: women’s health, vision care, and mental health.

Three years later at the Leaders’ Meeting, the leaders divided into five groups, working with women from other communities.

Each group had a set of colorful, wedge-shaped pieces of paper, representing different health care initiatives:

- Mental health is purple
- Dental care is yellow
- Vision care is orange
- Occupational health is pink
- Nutrition & diabetes prevention is blue
- Women’s health is orange with stripes

The size of each wedge indicated its relative proportion of the annual health & well-being budget. The task: determine how you would spend the health & well-being budget, creating a pie chart to represent the overall spending priorities. Of course, resources are finite, so some initiatives must be left out of the budget.

A tool for democratic decision-making

Participatory budgeting was pioneered in Brazil as a democratic decision-making tool to allocate resources more equitably and bolster civic participation. It was used effectively in several poverty alleviation programs, producing better outcomes while increasing the community’s sense of ownership of their progress.

The logic of participatory budgeting is that community members are the best-equipped decision makers and stewards of resources,given their deep knowledge and personal investment in good outcomes. In our case, the approach fits one of the four top priorities in our Strategic Plan: Increase artisan agency: develop strategies for artisans to participate in organizational decision making.

Emerging consensus

Our team circulated among the groups, listening to the conversations and witnessing different approaches to decision-making. We hadn’t given any instructions about how decisions should be made. I watched one group: each woman spoke in turn, sharing her perspective. One person mentioned that her preference would be to invest in vision care, but she knew her fellow group members would prioritize mental health. The group took an initial vote by show of hands (“Yes, we decided we’re a democracy!” one person joked to me), then returned to discussion.

We all gathered together again to hear the five final proposals. After everyone presented their case, the leaders rose for a final vote, placing a sticker on the proposal they found most compelling.

I saw a consensus begin to emerge: the two most popular options included the large yellow wedge representing dental care, filling almost the entire circle.

One year later

This summer, the leaders’ decisions began to bear fruit as the first groups visited the dentist for preventive care: exams, x-rays, cleanings, plus fillings and extractions as needed. Artisans enthusiastically agreed to invest a modest amount (Q30, about $4.50) toward their care, while Mayan Hands covers the rest. Our team researched extensively to find clinics who would be good partners and offer high-quality, fairly priced services.

As the artisan leaders decided, we will spend almost the entire annual health & well-being program budget on this dental care. The budget decision is theirs, because the health outcomes are theirs.

- Madeline Kreider Carlson, Executive Director

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Leadership and health programs, including annual meetings and health services, are funded by donations from our generous community. Thank you for making these meaningful opportunities possible.