The Republic of Haiti is a country of complex crises due mainly to natural threats such as hurricanes, earthquakes, droughts and floods, aggravated by socio-political and economic problems. With a Human Development Index (HDI 2016) of 0.493, an HDI adjusted to inequalities (IHDI 2016) of 39.6, a Gini coefficient of 60 (2001), in 2017 the Republic of Haiti ranks 165th out of 187 countries in the world, with the lowest HDI index in the northern hemisphere and the lowest in Latin America and the Caribbean. It is also one of the worst health indicators in the world and has not achieved the MDGs for maternal and newborn health and nutrition.
In addition, the atmospheric phenomenon of the Southern Oscillations, better known in the media as El Niño or La Niña, which are two opposite phases of the coupled ocean / atmosphere phenomenon called ENSO (El Niño-Southern Oscillation) and which has an overall impact on the planet, cyclically aggravates the precarious situation of the living conditions of the Haitian population, which, due to the drought of the past 6 years, has created a catastrophic situation in terms of food security and led to an unprecedented food crisis for 70 to 80% of the population and a worrying rise in malnutrition rates. Climate change aggravates deforestation initiated during the French colonisation for the export of precious woods to Europe, aggravated by the American occupation, and which has then steadily increased throughout the country through coal mining, which responds to the needs of a poor population who cannot afford gas stoves and regularly pay for their gas supply, which is too expensive for a family economy to survive.
With regard to the public health system, the national budget allocated went from 16.6% of the national budget in 2004 to 4.4% in 2017, which is totally insufficient to meet a constant increase in the population and the needs and demands of the population. In the MSPP, as in other ministries, the exception of assistantship in time and resources can become the operating standard, causing serious malfunctions at all levels of national health system.
According to the 2013-2016 National Strategic Plan for Reproductive Health and Family Planning, Haiti is one of 40 countries where, according to WHO, the maternal mortality rate was 380/100 000 in 2013 and 359/100 000 in 2013. 2015, according to the Mortality, Morbidity and Utilization Survey (EMMUS VI-2016-2017), the infant mortality rate is 59/1000 live births, one of the highest in the Caribbean and Latin America region .
In Haiti, the number of women of childbearing age is about 2.6 million, including 300,000 pregnant women and 30,000 with obstetric complications. Institutional deliveries are estimated at 35.9%, with a large variation between urban and rural areas (Port-au-Prince, 60.1% and 23.2%); according to the EMMUS VI 2016-2017 survey, the fertility rate for young people (15-19 years old) is 55 ‰ (35 ‰ in urban areas and 70 ‰ in rural areas) and up to 135 ‰ between 25 and 29 years old; the use of modern contraceptive methods is 31%. Haiti has only 6 health professionals per 10,000 population (compared to a minimum of 25/10,000 according to the WHO standard) and 37.5% of trained health personnel.
It is a country with recurrent needs in the health sector, especially for women and children under five, who are the most affected and therefore most likely to have their right to access basic health access care flouted. If we consider that 41% of households are headed by women and that 36% of the population is under 15, this vulnerability is even more obvious.
The emergence of "civil society" is relatively recent. At the moment there exist great coalitions or networks of organisations of the civil society, such as the National Network of Defense of the Human rights (RNDDH) which is an emanation of the National Coalition For Haitian Rights (NCHR - Haiti created in 1995), the National Election Observation Council (NOC), the Haitian Council of Non State Actors (CONHANE), the Civil Society Initiative (ISC), the National Advocacy Coordination for Women's Rights, the International Coalition Against Trafficking in Women - CATW Haiti, the Haitian Platform for Advocacy for Alternative Development (PAPDA), the Platform of Haitian Organisations of Human Rights (POHDH), the National Concertation Against Violence Made to Women, the Refugee and Repatriates Support Group (GARR), but also a multitude of associations and organisations spread throughout the territory with more or less representativeness and real social projection. On the other hand, it seems that some organizations lack a certain legitimacy, having no strong associative base, without adequate financial control, and a relative representativeness of the aspirations of the population they are supposed to support. Moreover, there is a secular distrust of the associative fabric towards all that represents the State which influences the constructive participation of the civil society in the promotion of a transparent and democratic governance, in the intersectoral contribution to the development of the public policies that meet the needs of the population, and the implementation of development initiatives in the territories. The international aid system and the strong influx of international NGOs after the earthquake of January 2010 is also an important aspect to understand the current structure of civil society.
The mission of MdM Spain, together with the MdM Network in Haiti, has a risk analysis matrix, an Emergency Preparedness Plan, strict security protocols (for example, hibernation in case of extreme political tensions), and a constant flow of communication and information transfer from the field to country coordinators, who periodically or as needed, are in contact with their respective headquarters.