The global focus on raising more and better aid and securing debt relief means there is a growing need for clarity on how aid should be spent. More broadly there are questions about what poor country governments must and can do to ensure the UN Millennium Development Goals (MDGs) are met. This report argues that the MDGs will not be achieved, and poverty will not be overcome, without universal access to quality basic services ? including health and education - provided through strong public systems. Informed by programme experience and research, this report highlights critical failings in the approach of many governments and donors to providing basic services for poor people, and the need for a shift in the international consensus about how to increase provision and access to basic services. It argues that only public systems can deliver the scale, equity, and sustainability of basic service provision needed to meet the MDGs and overcome poverty, and that governments and donors need to make radical changes in the way they prioritise, invest in, and support public systems. This accessible, well-referenced report looks critically at success stories in the provision of public services, with case studies from countries including Armenia, Mozambique, Nicaragua, Sri Lanka, and Uganda.