IN PORT-AU-PRINCE In the days after the earth shook and the government collapsed, the municipal nursing home here became one of the most desperate sights in Haiti, as old people lay swaddled in dirty sheets, huddled in cramped tents, begging visitors for water.
But little by little, order was restored. A humanitarian aid group called HelpAge International arrived at the nursing home. They paid salaries for security guards, health-care workers and cooks. The last building left standing was patched, and the elderly residents no longer were bathed with buckets in the yard.
But six months later, HelpAge abandoned the project after it failed to negotiate a new agreement with city hall. The group Project Concern International, which was operating a clinic on the grounds of the nursing home, also closed down after the mayor asked for rent.
The travails at the municipal nursing home illustrate both the promise and the perils of the unprecedented humanitarian aid response in Haiti.
Hundreds, maybe thousands, of nongovernmental organizations, known as NGOs, poured into the country after the Jan. 12 earthquake to provide emergency services. The groups - from international brand names such as Save the Children to unknown Baptist missionaries from Oklahoma - were supported by overwhelming global generosity, including more than $1.4 billion in donations from Americans.
But the effectiveness of the NGOs is now being questioned, by the groups themselves, and especially by Haitian leaders who complain that NGOs have become a parallel government hobbled by poor coordination, high turnover and a lack of transparency.
In the squalid camps where 800,000 people still languish, many Haitians routinely say their misery is exploited by NGOs to raise funds rather than raise them up from poverty. Children throw rocks at photographers from aid groups trying to take their pictures, demanding money.
Haitian officials speak of being "overrun" by "an invasion" of NGOs. Prime Minister Jean-Max Bellerive said that foreign NGOs operate in Haiti with little regard to government planning and that their presence, while necessary, can actually undermine long-term recovery efforts. By funneling most aid dollars through the NGOs rather than the government, which struggles with a legacy of corruption, the NGOs condemn the country to a cycle of dependence, he said.
Michel Martelly, the popular carnival singer who has become a top contender in the chaotic presidential election, promised that if elected, his government would rein in the NGOs and change how they do business in Haiti.
"We will allow them to function, but I will tell them what to do and where to do it," Martelly said in an interview. "We are going to impose a system to oversee what is done. We are going to get control of them."
The Disaster Accountability Project, a nonprofit staffed by law students and interns, solicited data from 196 NGOs operating in Haiti and got responses from 38 organizations, which reported that they had raised $1.4 billion in donations for earthquake relief in Haiti and spent $730 million on the ground.
Of the 196 Web sites operated by the NGOs in Haiti, only eight contained information the group considered "average or better than average" at transparency. "Most of the Web sites rely on anecdotes, aggregations and appeals to emotion," said Ben Smilowitz, the group's founder.
Aggregations are a common tactic in which an NGO or donor government compiles overall numbers - of latrines, meals, tents - and implies that it alone was responsible, when the tallies represent the work done by many.
It is difficult for an ordinary donor who writes a $50 check to know where the money goes.
Alex Cottin, a director for Merlin, an international health charity, issued a report asking "is Haiti's health care better?" after a year of massive aid and concluded: "To be honest, I'd say the answer is mixed."
Cottin said international groups came in and took over services. "What happened too often is that local health workers were overlooked and sidelined. I learned of one Haitian surgeon who reported going to the General Hospital to offer her services only to be told the international team had brought enough foreign personnel with them."
A report by the international aid group Oxfam on the one-year anniversary of the earthquake stressed that Haitian authorities need to show greater strategic leadership but that the international community should do much more to support the capacity of Haitian institutions rather than sidelining them.
Sylvain Groulx, head of the mission for the group Doctors without Borders, said, "It is true that a major, major challenge for the NGO community in Haiti has been coordination. We all need to ask ourselves, honestly, how have we done."
The 12 Haitian members of the Interim Haiti Reconstruction Commission sent its co-chairman Bill Clinton a letter in December protesting that they were "completely disconnected" from the decision-making process that helps shape how more than $4 billion in recovery aid is spent.
Of 1,583 contracts given in Haiti from the U.S. government totaling $267 million, only 20, for a total of $4.3 million, went to Haitian-owned companies, according to a review by the Associated Press.
Charity groups have been working in Haiti for decades, supplying a majority of health and human services, but the country is worse off economically than it was during the dark days of the dictator Jean-Claude "Baby Doc" Duvalier, ousted in 1986 and now under house arrest after his surprise return to Haiti two weeks ago.
Donors often prefer to funnel money through NGOs than the Haitian government because they fear the aid dollars will be squandered on cronyism and ineffciencies. Transparency International ranks Haiti 146 out of 178 countries in its Corruption Perception Index. The lack of faith has only increased in recent months in the aftermath of Haiti's fraud-plagued presidential elections that have left the country with a leadership vacuum.
At the municipal nursing home, Joseph Saintime, a young security guard, said that "when the NGO was here, the old people ate better, they had better care, a doctor came. But I don't think the NGO will ever come back. We are now alone."
Emmanuel Jean, a manager of the nursing home, sat in a barren office tallying figures. "The NGOs come and go, they don't have time to learn from us, the way we do things in Haiti. They don't know what we really need. They tell us what we need. This is why they can't work with us."
"When it was time to sign a new agreement with the mayor about our next phase of work at the home, he refused to work with us unless we paid his staff," said Caroline Graham of HelpAge. The group also thought the nursing home, in a tough slum and now surrounded by gangs and a tent camp filled with earthquake refugees, should be relocated. "We wanted to move them elsewhere, but the mayor would not allow it," Graham said.
For his part, the mayor of Port-au-Prince, Muscadin Jean-Yves Jason, complained in an interview about his former partners from the international aid community.
"They manifested their usual arrogance to city hall, they didn't do what they said they would do, they wanted to take over our nursing home, not help us, but take it over, and I asked them what do you want me to do, give you our old people as a present?" the mayor said.