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In 2000, the United Nations (UN) Member States pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarters reduction in the 1990 maternal mortality ratio (MMR; maternal deaths per 100 000 live births), to be achieved by 2015. This target (MDG 5A) and that of achieving universal access to reproductive health (MDG 5B) together formed the two targets for MDG 5: Improve maternal health. In the five years counting down to the conclusion of the MDGs, a number of initiatives were established to galvanize efforts towards reducing maternal mortality. These included the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, which mobilized efforts towards achieving MDG 4 (Improve child health) as well as MDG 5, and the high-level Commission on Information and Accountability (COIA), which promoted “global reporting, oversight, and accountability on women’s and children’s health”. Now, building on the momentum generated by MDG 5, the Sustainable Development Goals (SDGs) establish a transformative new agenda for maternal health towards ending preventable maternal mortality; target 3.1 of SDG 3 is to reduce the global MMR to less than 70 per 100 000 live births by 2030.

This paper summarizes the key findings of an 'After Action Review' (AAR) that reflects a decade of experience in designing and implementing ten HIV/AIDS projects in the Caribbean, financed by the World Bank. The objective is to identify what worked (and what didn't) in the project approach, design and implementation, distilling useful lessons for other projects in small states.

Primarily a disease of young adults, Acquired Immuno Deficiency Syndrome (AIDS) imposes economic costs that could be devastatingly high in the long run by undermining the transmission of human capital the main driver of long-run economic growth across generations. AIDS makes it harder for victims' children to obtain an education and deprives them of the love, nurturing, and life skills that parents provide. These children will in turn find it difficult to educate their children, and so on. An overlapping generations model is used to show that an otherwise growing economy could decline to a low level subsistence equilibrium if hit with an AIDS type increase in premature adult mortality. Calibrating the model for South Africa, where the HIV prevalence rate is over 20 percent, simulations reveal that the economy could shrink to half its current size in about four generations in the absence of intervention. Programs to combat the disease and to support needy families could avert such a collapse, but they imply a fiscal burden of about 4 percent of Gross domestic product (GDP).