One year after a 7.0-magnitude earthquake killed more than 200,000 Haitians and left 1.5 million homeless, conditions in the Western Hemisphere’s poorest nation are still grim. Cholera has killed 3,600 people and weakened many more; the UN warns that 650,000 may be affected over the next several months, and the death rate from the disease is an “unacceptably high” 3.6%. Elections in November were accompanied by widespread charges of fraud and voter intimidation, and it’s still unclear which candidates will face off in an upcoming runoff.

More than a million Haitians still live in makeshift camps and huts, and many neighborhoods are still choked with rubble. Human rights lawyer Mario Joseph — one of several Port-au-Prince residents profiled by Alertnet — reports that rape cases have tripled and Haiti’s justice system isn’t responding appropriately. The Root’s Jeff Dreyfuss offers a grim assessment of the situation and wonders about the role of NGOs:

After a year, just 5 percent of the rubble from the powerful 7.3 earthquake has been cleared; less than 10 percent of the $5.3 billion pledged after the quake has been disbursed. Thousands of NGOs (nongovernmental organizations), from the massive Red Cross to tiny volunteer religious groups, are on the ground.

No doubt, many of the NGOs saved lives and provided badly needed care. But their efforts are uncoordinated and often at cross-purposes with government policies. For example, the flood of volunteer doctors providing free emergency care has forced several Haitian hospitals into bankruptcy, weakening an already fragile medical ecosystem. Camps run by charitable organizations or celebrities like Sean Penn have discouraged some Haitians from leaving the overcrowded capital or returning to habitable homes.

Haitians have taken to calling their country “the nation of NGOs” and begun to wonder if foreign aid is bad for them in the long term. It’s an important question: Thousands of organizations, many of them well-meaning, have toiled in Haiti in recent decades; they have made little discernible difference in the lives of most Haitians.

NPR’s Morning Edition investigates the charge that aid groups working in Haiti have spent relatively little of the donations they’ve raised to help the country’s earthquake victims. Reporter Carrie Kahn spoke to people from aid organizations and the UN, who pointed out that coordinating efforts between aid groups and with the government is time-consuming. (In one example, the government reportedly took months to allow the Red Cross to build homes on government-owned land and then took back half the land for a school.) A Red Cross representative also noted that spending money “wisely and transparently” can take time.

The Washington Post’s William Booth characterizes the aid work in Haiti as an effort that “saved many lives … but has done little to ease the suffering of ordinary Haitians since then.” Some Haitians feel that NGOs have used the tragedy to enrich themselves with donations. Booth reports that the influx of free goods and services from NGOs and foreign governments hurt businesses that sell food, water, and healthcare. The Haitian government wants NGOs to stop providing assistance in camps so people will feel a push to get back to their homes, rebuilding them if necessary.

There are some bright spots in the dark picture. Another of Booth’s articles focuses on a partnership that will build a garment-factory complex that’s projected to open in 2012 and create 20,000 new jobs. Another story from Kahn highlights one neighborhood’s slow-but-steady removal of debris using a hand-cranked machine to crush chunks of rubble. This modest success story resulted from a collaboration between residents and Catholic Relief Services, Kahn reports:

Soly Santhea and her family are living in one of the shelters in the same spot where their two-story house collapsed. It took them weeks to clear the rubble, but they had no other option. Her mother, father and two siblings were living in a nearby tent encampment, but a few months ago, the owner of the land evicted everyone.

“We never even dreamed of coming back here,” she says. “Everything was so destroyed. You couldn’t even get into the neighborhood.”

Santhea says she went to the CRS office over and over again, and staff finally came up with the idea to bring in the hand-cranked rubble crusher.

Her mother, Ferdilia Escane, says if it weren’t for Santhea, dozens of families wouldn’t have been able to clear their lots and come back home.

“She was key in getting our neighborhood cleaned up,” she says. “It’s not just me saying this; everyone here knows what she did. She got us organized, got us help. And she is just a girl. I am so proud of her.”

Such stories are encouraging, but Haiti will also need widespread improvements in governmental institutions and infrastructure in order to thrive.