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With a decade to go until the deadline for the Millennium Development Goals, it is clear that key targets on health agreed by heads of state in 2000 will be missed--not for want of knowledge and technical tools but lack of political will and resources. Using a baseline of 1990, the targets state that by 2015: the number of people suffering from malnutrition and extreme poverty should be halved; infant and child mortality reduced by two-thirds; maternal mortality be slashed by three-quarters; and the spread of communicable diseases such as HIV/AIDS, tuberculosis and malaria reversed. Other targets include gender equality; universal access to primary education; and more widespread sanitation and drinking-water. In his annual report to the General Assembly on implementation of the Millennium Declaration, UN Secretary-General Kofi Annan said a "major breakthrough" would be needed in order to achieve the targets. Much of Asia and North Africa was on track to halve extreme poverty, he said. Countries in Latin America, the Caribbean and West Asia were making good progress towards goals such as education but were less successful in combating poverty. Sub-Saharan African and some least developed countries in other regions were "far from making adequate progress on most goals," Annan's report said. "The record of the last 12 months for the poorest is hardly encouraging," he said. "The number of HIV/AIDS infections was higher in the last calendar year than ever before, raising serious concerns about the development prospects for whole regions of the world in which hundreds of millions of people live." The document, released at the end of August, drew heavily on the findings of the draft interim reports from the individual task forces of the Millennium Project, chaired by Professor Jeffrey Sachs of Columbia University, and on country reports. While the interim reports did not provide significant new insights into novel forms of treatment or prevention, they helped draw attention to the lack of resources, according to Dr Andrew Cassels, Director of Health and Development Policy at WHO. "The knowledge is already out there and being applied," Cassels told the Bulletin. "What's new is the recommendations on how the MDGs can be used to focus attention on the resources needed for their achievement." Jan Vandemoortele, Director for Poverty Reduction at the UN Development Programme (UNDP), said the interim reports helped put poverty and ill-health "on a front-burner". But their practical impact would depend on the ability of developing countries to tailor the accumulated knowledge to specific national and local needs, and whether donor governments are willing to finance that effort, he said. The task force reports made it clear there were no quick fixes to lack of basic infrastructure and crumbling health systems, or the chronic shortage of health workers which was singled out as one of the biggest obstacles to tackling HIV/AIDS, malaria and tuberculosis. They also reflected hurdles caused by political sensitivities over issues like reproductive health, which was not initially included in the targets, and access to essential medicines, which split the task force to such an extent that its two pharmaceutical industry members issued a dissenting statement. Infant and maternal mortality Task Force Four said the overall picture was "worrisome indeed," with 10.8 million children under the age of five dying each year and mortality rates in some parts of sub-Saharan Africa increasing. It said deaths from diarrhoeal diseases and vaccine-preventable conditions had fallen since the 1970s, but there was little progress on acute respiratory infection. Only 16% of countries were on track to meet the child mortality targets, none of them in sub-Saharan Africa, it said. The report cited studies published last year in the Lancet of 23 high-impact interventions. …

The knowledge is there to achieve development goals, but is the will?