The epicentre of the child health emergency is sub-Saharan Africa and South Asia.

Around half of all deaths occur in just five countries: India, Nigeria, the Democratic Republic of Congo, Pakistan and Ethiopia.

Most of the worst affected countries are poor, and many are poorly governed.

All of them are characterised by high levels of health inequality, between rural and urban areas, and between rich and poor.

Whether or not the Millennium Development Goal to cut child deaths is achieved will be decided mainly within the poorest countries. However, the world’s richest countries have a critical role, in ensuring that no national plan to achieve child health is allowed to fail through a lack of resources. 

Any increases in the level of aid for health must be accompanied by far-reaching changes in where and how that aid is spent.

Too often the efforts of rich countries and institutions are scattergun and poorly thought through. 

The 30 worst affected countries account for four-fifths of all child deaths, but less than half of the aid for health.

It's vital that the global economic downturn isn't allowed to threaten progress or used as an excuse not to take determined action.

The next five years provide a narrow window within which governments could turn this shocking situation around - if they want to.