This report explores why resources are not reaching those who need it most and why progress is slow, uneven, and unjust. Among the reasons mentioned in the report: political priorities lead governments to favor other sectors, improve places already served, or exclude poor and marginalized groups. Furthermore, aid is not well-coordinated, is only loosely targeted according to need, and its effectiveness is constrained by red tape and lack of alignment with government systems. The report recommends key actions for national governments, donors, international agencies and civil society to break the vicious cycle of low investment and poor performance and get off-track countries back on-track to meet the MDGs.