The challenges that face Africa in the sphere of health care are formidable and often daunting. After decades of stagnant or worsening poverty and health indicators across the continent, the Millennium Development Goals (MDGs) — adopted by the United Nations at its Millennium Summit of September 2000 — have set benchmarks for improvements in the health picture. If accomplished, the MDGs would represent major advances in the well-being and survival rate of millions of people. Those goals envision that by 2015 child mortality can be reduced by two thirds, that maternal mortality can be reduced by three quarters, and that infectious diseases such as malaria, tuberculosis, and HIV/AIDS — which threaten to do even more damage tomorrow than they do today — can be held in check and indeed reversed. Are these goals realistic? In Tanzania, recent experience in the large rural districts of Rufiji and Morogoro gives us cause for optimism. Over 4 years, child mortality within these districts (with a combined population of more than 700 000) has fallen by more than 40%, which puts them well on the way to achieving the MDG related to child health. We attribute these gains not to a single intervention but to a range of simple measures to improve health system efficiency and to allocate health funds more in proportion to the local causes of mortality (quantified using data collected from Demographic Surveillance Systems).