Without vital new investment, there is no chance of reaching the Millennium Development Goals (MDGs) of improving health care worldwide, and millions of people in developing countries will continue to die annually from mostly preventable diseases, according to a new United Nations report released recently.

"Providing universal access to broad-based health services could save several million children's lives each year," UN World Health Organization director-general Lee Jong-wook.

"That would reverse the downward trends and bring us two-thirds of the way to meeting the child mortality goal, and 70 to 80 per cent towards meeting the maternal mortality goal," he added of the targets set by the UN Millennium Summit of 2000.

These include cutting the mortality rate among children under five by two thirds and the maternal mortality ratio by three quarters and halting and beginning to reverse the spread of HIV/AIDS and the incidence of malaria and other major diseases.

The report, Health and the Millennium Development Goals, WHO's first study of progress made so far, points to weak and inequitable health systems as a key obstacle, including particularly a crisis in health personnel and the urgent need for sustainable health financing.

"We have the treatments; the technology is known and affordable. The problem in many countries is getting the staff, medicines, vaccines and information to those who need them on time and in sufficient quantities. In too many countries, the health systems to do that either do not exist or are on the point of collapse," Dr. Lee said.

Annual avoidable deaths in developing countries at present include almost 11 million children under five; about 1 million people from malaria; and more than half-a-million women in pregnancy and childbirth. The HIV/AIDS pandemic takes a further 3 million lives each year.

"Building strong health systems requires improvements across governments - in public financial management, manpower planning, roads and infrastructure, and many other areas," Dr. Lee said adding, "We need to look beyond the health sector if we are to be successful, and we must take an integrated approach. If we do, success is possible."

With less than 10 years to the target date, none of the poorest regions of the developing world are on track to meet the child mortality target. For maternal mortality, declines have been limited to countries which already have lower mortality levels. The goal of reversing the spread of HIV/AIDS and reversing the incidence of malaria and other communicable diseases remains a huge challenge in sub-Saharan Africa. The safe water target may be achieved globally, but not in sub-Saharan Africa, says the study report.

At least $30-40 per capita is needed annually to finance a minimum health package, but many poor countries invest far less, on average $10 per capita, and in some countries, as little as $2 per capita. The UN Millennium Project recently said that meeting all the MDGs would require an estimated $135 billion of Official Development Assistance, rising to $195 billion by 2015.

"Global political commitment for long-term financing of the MDGs is crucial," WHO Director of MDGs, Health and Development Policy Andrew Cassels said adding, "We must use all potential means of raising resources, including debt relief. We need resources which are predictable and sustained to allow countries to make long-term plans. And health must be at the centre of these efforts."

In many countries, particularly in Africa, lack of staff is at the centre of the health systems challenge. "Out-migration, deaths from AIDS and above all, poor pay and conditions have created a human resources crisis," WHO director of Measurement and Health Information Systems Ties Boerma said. "Ninety per cent of Africa lives in areas where there are fewer than five doctors per 10 000 people," Boerma added.