Integrated village-based development projects are experiencing a renaissance in Africa and elsewhere. This has coincided with the apparent inability of many countries to make much progress on the Millennium Development Goals (MDGs). The Millennium Villages Project (MVP), developed by a team of scientists at The Earth Institute, headed by Jeffrey Sachs, is among the most high profile of these village-based projects. It supports an integrated package of proven interventions in health, agriculture and other sectors to lift inhabitants above the poverty threshold. This paper draws on a recent review of the MVP to ask what is needed if the numerous current village-level efforts to improve livelihoods are to have better prospects of being sustained and implemented on a wider scale.