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The island nation of Haiti is the poorest country in the Western Hemisphere and one of the poorest in the world. Nationwide, Haiti’s per capita income falls well below a dollar day, at about $240 annually. Two-thirds of all Haitians are unemployed or underemployed, and approximately the same proportion depend on subsistence farming for survival.

Reflecting the country's grim economic statistics, the health of the Haitian people also ranks as the worst in the hemisphere. Haiti has the worst malnutrition, the highest rates of infant and maternal mortality, and the worst AIDS epidemic in the Americas. Nearly half the population is chronically undernourished. Healthy life expectancy at birth is only 43 years. Of every thousand children born in Haiti, 139 die before reaching the age of 5, in stark contrast with nearby Cuba where the rate is only 7.5 deaths for every 1,000 live births. The leading causes of child mortality are diarrheal diseases, acute respiratory infections, and malnutrition. Acute respiratory infections and diarrheas cause half of the deaths in children under five years of age. Only half of the child population is vaccinated. Infectious diseases, led by HIV and TB, are the major causes of adult mortality. Maternal mortality, largely due to obstructed labor and hemorrhage, is at 523 per 100,000 live births, compared to less than 20 per 100,000 in the United States and only 2 per 100,000 in Sweden.

The eighty percent of the Haitian population who live in abject poverty and bear the brunt of the burden of disease have little access to health care, especially in rural areas. The 2005 World Health Report estimates that the Haitian government spends only $2 per capita on health each year, accounting for about 40 percent of national expenditures on health. Since health insurance is not available or affordable for the vast majority of Haitians, households must pay for health care or go without. Almost three quarters of private sector spending on health care takes the form of out-of-pocket expenditures.

The country is divided into nine departments and 133 municipalities. On paper, the Ministry of Health in Haiti (MSPP) is structured at the central and departmental levels, with a hospital in each department and a health center in every municipality. Because the health budget is low, this structure is not functional, and most of the “departmental” hospitals are run by nongovernmental organizations (NGOs).

The already dire public health situation has been exacerbated in recent years by a U.S.-backed embargo against the elected government of President Jean-Bertrand Aristide and then by the coup that drove him from office. The public health system, which President Aristide had tried to strengthen, was further crippled when the U.S. vetoed disbursement of $146 million in loans that had already been approved by the Inter-American Development Bank. What little health aid the U.S. and the European Union did provide to Haiti after Aristide was elected in 2000 went only to NGOs.

Dismal health outcomes are especially pronounced in the country’s rural interior, where deforestation, erosion, and lack of infrastructure have crippled the agricultural economy. This region is home to only ten percent of the population, but they are the poorest people in Haiti. This is the area in which ZL works.