It’s been just over four years since a devastating earthquake killed more than 100,000 Haitians and left 1.5 million homeless. An estimated 20 to 40 percent of civil servants died in 35 seconds, wiping out the government’s already shaky capacity. Only one government building withstood the 7.0 quake.

In the immediate aftermath of the tragedy, the world prioritized relief and threw money at the suffering.  Private donors gave $3.1 billion. The international community pledged around $10 billion and dispersed about $6 billion, the majority on relief.

So much money, so many players, so little progress.  Four years later, a complete lack of essential public services and government functionality is the international community’s legacy. Today, about 150,000 men, women, and children still live in the 127 camps that remain, according to the International Organization on Migration. The billions of dollars still haven’t brought running water to most of the country.

Haiti had extreme problems far pre-dating the quake that should have been central to the planning for any realistic solution. It had virtually no industry or exports, farmland destroyed by deforestation, and the most privatized education system in the Western Hemisphere, condemning most of the population to a cycle of poverty. In Cap-Haitien, on the northern coast, a 70-year-old midwife told me that parents sometimes pay for the first semester but cannot afford the second term. These children will often dress in their uniforms and still show up every day, only to be turned away for tuition non-payment. Despite 30 years of war, Afghanistan, where I’ve traveled extensively, seems surprisingly better off than our Caribbean neighbor.

Over 10,000 NGOs have been documented operating in Haiti since the earthquake, according to the United Institute of Peace. Only 1 percent of donor funding has gone directly to the Haitian government. What did we expect to happen? That absurd funding imbalance guaranteed an addict/dependency state, where emergency needs are attended to by outsiders, but minimal effort is made to rebuild, train, or try out any sort of Haitian institutional infrastructure to attend to those same needs going forward. Instead of bankrolling an aid industrial complex that hasn’t worked, Haitians deserve a chance to fail or prosper on their own terms.

This is a situation that demands a greater percentage of relief funding channeled to long-term systematic assistance to build a foundation of an economy, not less. An industrialized power like Japan or even South Korea could withstand a disaster and just requires emergency assistance, because they have the groundwork laid for a successful economy to return to. When a shambles like Haiti is wiped out, it’s back to the drawing board after each disaster.

Some projects have rejected the paternalistic model and found striking success actually trusting the Haitians as long-term partners.

Lack of transparency on how our development funding gets spent is a big part of the problem.  There’s already scant oversight into how we spend our U.S. Agency for International Development funding budget. USAID spent $270 million in Haiti last year, and most of the spending went to for-profit American companies who do not publicly provide their budgets.

So while multilaterals, foreign donors, and nonprofits initially provided essential relief, other private companies and humanitarian organizations became very rich in the reconstruction phase. The for-profit Chemonics International has received more than $58 million in USAID funding for development projects in Haiti, with little quantifiable success, except ranking No. 45 in a 2012 list of Washington, D.C.’s most profitable contractors.

One Chemonics project was urban beautification in the towns near the much-lauded Caracol Industrial Park in northern Haiti. Project workers planted seedlings in the town center. The seedlings died. As the inspector general explained in a 2012 USAID audit, “residents did not understand how the activity led to the beautification of the area, nor did they associate it with the industrial park.”

But there are nonprofits who have made a difference in Haiti—and these projects overwhelmingly are partnered with the Haitian government.

Some projects have rejected the paternalistic model and found striking success actually trusting the Haitians as long-term partners. The University Hospital in Mirebalais is a case study in how to build lasting change while also attending to the immediate needs of the sick and dying. It’s a public teaching hospital administered and funded through public-health pioneer Dr. Paul Farmer’s Partners in Health, with such a high standard of care I’d be treated there any day. Instead of eschewing advanced medical care because there’s such limited access to the basics, they teach local doctors how to provide it via a residency program.

Partners in Health made a $25 million investment to build a world-class facility, which operates annually for $16.2 million. In the dark of night, a line of patients grows to the hundreds. An average of 700 patients are treated a day. The 200,000-square-foot facility is powered by solar energy so that frequent power outages do not disrupt care. Each bed has its own oxygen unit supplied in-house, and there’s neo-natal intensive care, and a post-partum recovery room with chairs that convert to beds so fathers or family can also stay overnight. The mental-health unit has helped earthquake survivors deal with grief and post-traumatic stress.

Partners in Health and its Haitian NGO counterpart are now in the lead, but the Haitian government has agreed to manage the hospital in 10 years.

NGOs that work locally to tackle the grittiest problems should also be encouraged. The 2010 cholera outbreak from sewage in a United Nations camp in Mirebalais underscores the need for improved sanitation. It’s perhaps the least sexy development project to tackle, and among the most basic and important. More than 20,000 Haitians have access to the SOIL project’s locally sourced compost toilet. The SOIL project, operating in Haiti since 2006, turns human waste into compost at the largest sanitation treatment site in Haiti. Paid local toilet managers in the community are responsible for upkeep, and the sale of the compost will hopefully allow the organization to become self-sustaining—and increasingly create more jobs in these communities. SOIL’s founder, Dr. Sasha Kramer, hopes to translate success on a small scale to a model where the private sector manages the compost and the government purchases it to re-sell to farmers at a subsidized price.

It’s the right instinct—demonstrate sustainable local success, and let the Haitians lead. Incrementally.  Four, eight, or 50 years of doing it for them and then abandoning them to their own untrained, unsupported, unsustainable devices is a failed model.

Haiti has a chance to change post-earthquake, and so should our thinking when it comes to development.

There’s a moral argument that we should be just as accountable of do-gooder dollars as do-gooder bombs. If there’s a “responsibility to protect” civilians from genocide, shouldn’t there be a responsibility to not infantilize and doom an entire society to poverty? If bankrolling the aid industrial complex keeps the government powerless and otherwise broke, there is no hope for Haiti.