The global aid architecture in health has changed over the past decade, with the adoption of the Millennium Development Goals (MDGs) and a major expansion of the levels and sources of development assistance, particularly for low-income countries. While key health outcomes such as infant survival and nutritional stunting have improved over the decade in every developing region, nearly three-quarters of developing countries are either off track or seriously off track for achieving the MDG for reducing under-five mortality. Maternal mortality is declining at only 1 percent each year, a fifth of the rate needed to achieve the goal.