All children have diarrhea from time to time, but children who live in houses with dirt floors have it often. When young children crawl and play on dirt floors, they are likely to ingest fecal material, exposing them to the harmful worms and parasites that thrive in excrement.source These pathogens can cause persistent diarrhea, among many other ailments. Worldwide, diarrhea kills around 750,000 children every year.source

In 2000, Enrique Martínez y Martínez, governor of the Mexican state of Coahuila, launched a program to replace dirt floors with cement ones. The program was called Piso Firme (“Solid Floor”), and it provided more than 34,000 homes with much-needed cement flooring upgrade by 2005.source The success in Coahuila, coupled with the governor’s strong influence at the federal level, eventually led to a national commitment by president Felipe Calderon to eliminate dirt floors in target areas across Mexico. By 2012, the total number of cement floors installed had reached 2.7 million.source

In 2006, an independent impact evaluation funded by the Coahuila State and the federal Secretariat for Social Development found that children under six had nearly 20 percent fewer parasites, a 13 percent lower prevalence of diarrhea, and 20 percent less anemia than children whose households did not participate in Piso Firme. The program also reduced mothers’ levels of depression and perceived stress by 12.5 percent and 10.5 percent, respectively. Even more, the Mexican government, using a broad approach to poverty measurement, also reported that the floor upgrades actually reduced poverty.source


Mexico’s program is a valuable contribution to the evidence base on how cement floors and other targeted housing improvements can improve health and well-being for slum-dwelling children and the women who care for them.

The program’s financial support came from state and federal budgets. In Coahuila State, the total program cost US$5.5 million (US$162 per household). The federal government spent US$1.27 billion from 2007 to 2013 (US$468 per household).source

Mexico stands out for its top-notch evaluation system, which enabled the national Piso Firme program to rest on a strong foundation: the association between cement flooring and child health gains that had been established by the impact evaluation. This attracted government funding and sustained political commitment that facilitated scale-up.

Piso Firme has been a big win for Mexico, one with implications for other middle-income countries with growing slum communities that have begun investing in improving living conditions and housing stock for the poor. Mexico’s experience shows that simple interventions are worthwhile, especially when they are subjected to an impact evaluation and results are published in peer-reviewed journals. Mexico’s program provided lessons in targeting, equity, and operational improvements to improve public health.