Many resource constrained countries are unlikely to attain their millennium development goal targets by 2015,1 despite major global efforts and much progress (figure⇓).2 3 For example, only 23 countries are currently estimated to be on track to achieve the target of a 75% reduction in maternal mortality.4 In addition, the rate of new HIV infections continues to outpace the number of HIV positive patients who start treatment—for every five people newly infected with HIV only two begin treatment each year, and about 5.5 million people needing treatment for HIV in low and middle income countries still do not receive it.5 6