Child mortality is a sensitive indicator of a country’s development and telling evidence of its priorities and values. Investing in the health of children and their mothers is not only a human rights imperative, it is a sound economic decision and one of the surest ways for a country to set its course towards a better future. Impressive progress has been made in improving the survival rates and health of children, even in some of the poorest countries, since 1990. Nonetheless, achieving Millennium Development Goal 4 (MDG 4), which aims to reduce the global under-five mortality rate by two thirds between 1990 and 2015, will require additional effort. Attaining the goal is still possible, but the challenge is formidable. Reaching the target means reducing the number of child deaths from 9.7 million in 2006 to around 4 million by 2015. Accomplishing this will require accelerated action on multiple fronts: reducing poverty and hunger (MDG 1), improving maternal health (MDG 5), combating HIV and AIDS, malaria and other major diseases (MDG 6), increasing the usage of improved water and sanitation (MDG 7) and providing affordable essential drugs on a sustainable basis (MDG 8). It will also require a re-examination of strategies to reach the poorest, most marginalized communities. The remarkable advances in reducing child deaths achieved by many developing countries in recent decades provide reason for optimism. The causes of and solutions to child deaths are well known. Simple, reliable, and affordable interventions with the potential to save the lives of millions of children are readily available. The challenge is to ensure that these remedies – provided through a ontinuum of maternal, newborn and child health care – reach the millions of children and families who, so far, have been passed by