The real curse of world poverty is the lack of access to crucial services such as education and healthcare, the World Bank has warned.
Governments are still failing to deliver
In its latest World Development Report, an annual examination of the state of poorer economies, the World Bank has focused on provision of services.
Without improvement in services, the Bank said "freedom from illness and freedom from illiteracy - two of the most important ways poor people can escape poverty - will remain elusive to many."
At the same time, even modest investments in education, sanitation, nutrition, electricity or other necessities can pay huge dividends for the developing world.
War on waste
The World Bank - whose annual joint meetings with the International Monetary Fund (IMF) are under way in Dubai - is hoping to influence the debate on the future of aid.
Donor countries have pledged to increase aid over the next few years, amid warnings that the so-called Millennium Development Goal poverty reduction targets may not be met.
The goals call for a halving of global poverty, as well as broad improvements in various aspects of human development, by 2015
By arguing the case for improvements in services, the World Bank hopes to ensure that increased aid is not wasted.
So far, the bank warns, shoddy services are responsible for incalculable suffering.
Many basic services are completely lacking: 2.5 billion people worldwide have no access to improved sanitation, for example.
World Bank chief James Wolfensohn wants to spark a debate
But the real issue is the poor quality of the services that exist, the Bank said.
The Middle East, for example, spends more per head on education than any other developing region, but has some of the highest illiteracy rates.
Only 41% of Angolan children are immunised against tuberculosis, compared with close to 100% throughout the rich world.
And only 12% of births in Bangladesh are attended by skilled medical staff, compared with near-universal midwife coverage in developed economies.
A little effort can make a significant difference, the Bank said.
A Mexican initiative to give cash to poor households if they attended a clinic regularly and sent children to school reduced childhood illness by 20% and increased secondary enrolment by up to 8 percentage points.
In Indonesia, revenues from oil exploration were directed to education, doubling primary school enrolment to 90%.
But economics often eliminates the incentives for such projects, leaving developing-country governments and service providers with little interest in targeting the poor.
"Services can work when poor people stand at the centre of service provision - when they can avoid poor providers, while rewarding good providers with their clientele, and when their voices are heard by politicians," said Shanta Devarajan of the World Bank's Human Development Network.