Confronting Africa's health crisis: more of the same will not be enough

The international community needs to rethink its approach to Africa if it wants to produce sustained improvements in health At current rates of progress, sub-Saharan Africa will not achieve any of the millennium development goals. 1 In health, the situation is especially bleak, with little or no substantive progress since 1990. All key health indicators are at much worse levels than those in any other of the world's developing regions (with the exception of malnutrition in children under 5 in South Asia, but there the situation is improving). 2 3 In this article, we critically examine the main approaches currently supported by the international community for accelerating progress towards the health related goalsincreased aid, reform of the health sector, and global health initiatives-and outline an alternative approach for improving the health of African people.