The rich world is running dangerously short of time to redeem its promises on helping the poor, the United Nations says.
Despite three years of concerted effort, some countries have recently begun to get poorer.
It is touch and go as to whether the goals will be met
On present trends, some African countries will not vanquish poverty until 2165, the UN Development Programme (UNDP) believes.
It says poor countries must introduce reforms, while rich ones improve trade and aid.
Releasing its Human Development Report 2003, the UNDP says poverty is not inevitable. In the last 30 years, life expectancy in poor countries has risen by eight years, and illiteracy has been halved.
But it says progress towards achieving the Millennium Development Goals (MDGs) is patchy, with success still uncertain.
The MDGs, agreed by the UN in 2000, aim to halve world poverty by 2015. Their scope includes hunger, disease, illiteracy, environmental damage, and halting the spread of HIV/Aids.
The UNDP says the goals can be achieved, but "only if poor countries pursue wide-ranging reforms and wealthy ones respond with improved trade terms and increased aid".
EFFORTS TO BEAT POVERTY
Read the key points and see graphs from the UN's Human Development Report 2003
Mark Malloch Brown, UNDP's administrator, told BBC News Online: "I think there's a real shot that most of the countries will have met most of the goals by 2015 - but the next couple of years will be critical.
"We're at a very dangerous moment. The agreement on the goals started a build-up of emphasis on global development.
"But against that, the old politics is reasserting itself. Italy, France, Germany, Japan - even the Netherlands, one of the most generous donors - are all making cuts in spending.
"You've got a real difficulty keeping people on track. Development assistance is the first to go when public spending faces cuts.
"There are 12 years till 2015, but the world is already into overtime on achieving the development goals."
The UNDP says its report documents "an unprecedented backslide... in some of the world's poorest nations".
"More than one billion people still live in extreme poverty, and for many living standards are getting steadily worse."
The report identifies 59 priority countries where, it says, the MDGs will not be met without urgent action.
In 31 top priority countries, progress towards the goals has stalled or even begun to reverse.
Of the 59 priority nations, 24 suffer from a high incidence of HIV/Aids and 31 have unusually high foreign debts.
The report proposes a millennium development compact, a new mechanism designed to ensure the goals are met.
It would require doubling annual development aid from the rich world to $100bn (£60m), dismantling unfair trade subsidies and tariffs, writing off unsustainable debt, and creating better access to technology.
Protestors at the Johannesburg World Summit demanded action
The UNDP says: "Only 10% of research and development focuses on the health problems of 90% of the world's people.
"Rich countries have undermined the right of poor countries to make life-saving drugs available to their people at affordable prices."
Yet technology, together with better targeted aid, it says, could make a huge difference to problems like low soil fertility, isolation from trading routes, and preventable diseases.
Most of the countries that were poorer in 2000 than in 1990 are in sub-Saharan Africa.
The UNDP says landlocked countries generally do worse than coastal ones, as do those which are tied to a single export commodity.
Its report includes its annual human development index, measuring countries' progress on key social and economic indicators.
Ranked according to their national levels of poverty, illiteracy, unemployment and life expectancy, Sweden tops the list of rich countries, with the US at the bottom.
Sweden, with a lower per capita income than the US, has on average more functionally literate adults and fewer people living in poverty.