Poverty is the main reason why babies are not vaccinated, clean water and sanitation are not provided, curative drugs and other treatments are not available, and mothers die in childbirth. It is the main cause of low life expectancy, handicap, disability, and starvation, and a major factor in mental illness, stress, suicide, family disintegration, and substance abuse. Poverty is spreading, just as the gap between rich and poor is growing in both developed and developing countries. In 1989, the World Health Assembly asked the World Health Organization (WHO) to pay attention to the special needs of the most poor countries, a request which led to the development and launching of the Intensified Cooperation with Countries and Peoples in Greatest Need initiative. The goals of the initiative are to enable poor countries to develop public policies and implement strategies for improving the health status of their populations, to promote innovative intersectoral action, and to make the best possible use of international cooperation in health matters. The main task has been to develop and implement community-based strategies for primary care in approximately 30 countries. In-country actions are described for Angola, Bangladesh, Bolivia, Burkina Faso, China, Guatemala, Guinea-Bissau, Moldova, Myanmar, Vietnam, and Yemen. Lessons learned are presented and future requirements considered.