By Jo Chandler, The Age

THE clock is ticking in New York. It's a large, illuminated clock in Times Square, not far from the United Nations headquarters, where 140 world leaders and countless development activists gathered this week to evaluate progress on promises they made 10 years ago to make the world a better place.

The clock maintains a silent, sober vigil on behalf of the invisible people everyone at the summit is talking about. As it measured the 60-something hours that had expired between the opening and closing speeches tracking the UN Millennium Development Goals, the Amnesty International ''Maternal Death Clock'' also ticked off the toll of women dying in childbirth somewhere on the planet - one every 90 seconds.

As the last of the delegates shuffled out with their papers, more than 2400 women had died an agonised, often lonely death. And counting. Progress on goals to make mothers and their newborns safer has been the most fraught and elusive of the eight development goal targets for health and wellbeing.

In the final hours of the three-day UN summit, much hoopla accompanied announcements pledging more momentum and money to campaigns to rescue mothers and babies, and in so doing to salvage fading hopes for meeting the ambitious promises made by world leaders to the world's poor back in 2000 - the greatest promises ever made, according to UN Secretary-General Ban Ki-moon.

With five years to go until the target date for achieving the goals - to halve poverty and hunger, improve health, educate every girl and boy, empower women, ensure global sustainability - Ban launched a strategy aimed at saving the lives of 16 million mothers and children by 2015, announcing pledges of about $US40 billion ($A42 billion) from governments and aid agencies to underwrite it.

At this late stage in the game, targeting efforts for maternal survival is seen to be particularly powerful because of the flow-on effect to other goals - children with healthy mothers have a better chance of being educated, vaccinated and well-nourished.

On another podium, Australia's new Foreign Minister, Kevin Rudd, joined US Secretary of State Hillary Clinton, British Deputy Prime Minister Nick Clegg and billionaire philanthropist Melinda Gates to announce that Australian, American and British aid agencies would join forces with the Gates Foundation in a new alliance to deliver family planning and the facilities for safe birth to some of the world's neediest women. The alliance will focus on co-ordinating efforts to train midwives, and extend access to contraception and basic health services.

At the launch of the UN's new Global Strategy for Women, Rudd said Australia would channel at least $1.6 billion of its increased total aid package over the next five years to improving the health of women and children. ''In 2010, we should not still be seeing women die in childbirth because they don't have access to a trained health worker. We should not be seeing children dying of vaccine-preventable disease.''

Rudd said more than 350,000 women and girls died each year from largely preventable complications related to pregnancy and childbirth.

Eight million children also died, including 3.5 million newborn babies.

''The progress has not been good enough for women in countries like Papua New Guinea, who are 80 times more likely to die in childbirth or pregnancy than an Australian woman.''

Indeed, maternal deaths doubled in PNG in the 10 years to 2006 - and this despite the investment of $A476 million into PNG health over the same period. Some 120,000 of PNG's 200,000 births each year are unsupervised, often occurring on a dirt floor, with no skilled person on hand and no equipment or medicine.

Speakers at a multitude of forums and workshops during the three days worked hard to galvanise participants and energise governments to get the Millennium Development Goals across the line in five years. The summit closed with a speech from President Barack Obama urging fresh energy in the campaign to haul the planet's ''bottom billion'' out of extreme poverty.

Dr Meredith Burgmann, representing Australian aid agencies in her capacity as president of the Australian Council for International Development, , told The Age she was impressed with the energy and calibre of the talks, and that she believed there was a genuine commitment by enough nations to see much more achieved by 2015.

But as the meeting broke up, many aid agencies and delegates were less upbeat, expressing cynicism and some deep pessimism, mostly because despite the plethora of new promises, many nations have failed to honor even old ones. They departed the summit raising concerns about the void between the rhetoric and the reality.

Ban Ki-moon's impassioned pleas for more momentum were undermined by his appeals to donors to honour their existing aid commitments, many of which fell by the wayside when the world economy crashed in 2008. Less than half of the funding pledged to Africa five years ago by the G8 has been delivered. ''The crisis is no excuse for letting up our efforts, but underscores the need for actions,'' Ban told the assembly.

UN officials estimate that at least $US120 billion will have to be found over the next five years if the development goals are to be achieved. There was no sign of that kind of money emerging from the summit.

Agencies also calculated that the $US40 billion pledged to Ban's new maternal health campaign only covers about half the price-tag required to achieve its ambitions.

There were also fears that in some instances, the pledges did not represent real new commitments.

''It's clear that rich countries are putting old promises with a seemingly big price tag in a new shiny UN wrapper, rather than announcing anything new for the world's poorest people,'' Oxfam spokeswoman Emma Seery said.

Joanna Kerr, the chief of Action AID, which targets hunger, dismissed the three-day summit as ''an expensive side show'' and ''an avalanche of warm sentiment [that] cleverly concealed the fact that no fully funded plans of action for tackling poverty were actually announced''.

Media commentators also betrayed their jaundice. London Guardian reporter Polly Curtis, accompanying Nick Clegg, blogged that she had attended a forum where Clegg, Bob Geldof, Graca Machel, Cherie Blair, Richard Branson and Geena Davis had debated how to get businesses involved in the cause. ''The event shows the organisation's sometimes extraordinary lack of self-awareness. Waiters served wine with a chicken salad followed by chocolate torte on linen tableclothes. The sign on one table read 'poverty and hunger'.''

Kevin Rudd's speech to the general assembly in the final session was that of a believer, though it recognised there had been failures and not enough progress had been achieved. ''The truth is we are not yet on track to register even the barest of pass marks,'' he said.

''Successes in some areas - poverty reduction and school enrolment - must be weighed against failures in others, including maternal health and child nutrition. Our failures have attracted vocal critics; those who say that international aid doesn't work; that it is wasted; that it is poorly managed; that there is no point. This is not Australia's view.

''Our view is that the richest among us have a profound responsibility to help the poorest … Poverty is degrading. Poverty is de-humanising. Poverty destroys human dignity.''

Rudd said part of the blame for failures in achieving the targets lay with donor nations that had not honoured their commitments. By contrast, Australia had met its pledges and doubled its aid budget since 2005, including a 200 per cent increase in aid to Africa. By 2015, aid funding is projected to double again.

Dr Burgmann said she felt Australia was ''punching above its weight'' in the forum in terms of government and NGO profiles. But she also observed that Australia had a pivotal role in ensuring that the needs in South-East Asia, and the Pacific in particular - where some nations had gone backwards or were tracking extremely badly in critical areas - were recognised.

Having sat through three 12-hour days of workshops and speeches, she said the only mention she heard of critical issues facing the Pacific - particularly PNG and East Timor - was when they were raised by Rudd.

The director of Oxfam Australia, Andrew Hewett, said he welcomed a pledge by Rudd to the assembly to channel 0.15 per cent of Australia's gross national income to the world's least developed countries. "This commitment means Australia will be helping the poorest of the poor get basics like enough food for their families, education for their children and access to healthcare," he said.

He also applauded the new global strategy spotlighting the needs of mothers and babies, and Australia's contribution to that. "But we now need to ensure that wealthy countries put their money where their mouth is and that this money doesn't prove to be little more than smoke and mirrors.''

Good quality aid, he said, can help to transform lives - since 1990 the number of people living in poverty around the world has been halved. Aid has helped 33 million more children go to school in developing countries.

"But almost a billion people around the world still go to sleep hungry each night. In one of Australia's neighbouring countries, Papua New Guinea, 3.9 million people lack access to safe, clean drinking water. The hard work starts today - governments must be accountable for their promises and provide aid that helps the world's poorest people," Hewett said.

The head of Save the Children, Suzanne Dvorak, said that while the Australian government was to be commended for raising its overseas aid budget to 0.5 per cent of gross national income, ''it can and must do better if it is to help halve global poverty by 2015. The UN target is 0.7 per cent of GNI - a view supported by four out of five Australians.

''We now need to continue with a major surge of political energy, put meat on the bones of the global strategy, and the [Millennium Development Goals] ARE achievable,'' Dvorak said. ''We owe it to every mother and child that this commitment ends up in real progress.''

World Vision chief the Reverend Tim Costello, said there were positives to be taken from the UN summit, including the sense of renewed focus on maternal and child health. However, he also said Australia was still paying ''a little less than our fair share'' and he urged an increase in commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria from current funding of about $45 million to $170 million a year.

UNICEF Australia communications director Tim O'Connor said the development goals remained a powerful mechanism for galvanising focus on ''the greatest challenge of our time: tackling extreme poverty''.

They had been successful on several crucial fronts. Global under-five mortality has fallen from 90 deaths per 1000 live births in 1990 to 65 in 2008. Vaccines have saved the lives of an estimated 2.5 million children. In more than 60 developing countries, at least 90 per cent of primary school-aged children are in school.

''What we do if we achieve the MDGs is to prove to ourselves as a global community that we are capable of working together and making huge changes in our world. Defeating poverty today is the equivalent of defeating slavery in the 19th century. If we show the world it is possible it will really prove to us all that as a global community acting together we are capable of achieving anything.''

What are the Millennium Development Goals?
1. Eradicate extreme poverty.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child morality rate.
5. Improve maternal health.
6. Combat HIV/AIDS, malaria, and other diseases.
7. Ensure environmental stability.
8. Develop a global partnership for development.

 Photo: Jason South