Despite the numerous development initiatives by multilateral and bilateral development agencies, Sub-Sahara Africa is home to the world’s poorest people and to many of the least developed countries in the world. Development theorists have utilised various theoretical perspectives to understand and explain the complex nature of the region’s underdevelopment. To date, optimism has faded into pessimism as many of the social indicators for Sub-Sahara Africa continue to deteriorate, raising more questions than answers regarding such a disparity. This article critically examines the reasons why Sub-Sahara Africa’s development continues to lag behind. Employing “Alternative development”, “Alternatives to development”, and Post-development” theories we explain why the Millennium Development Goals (MDGs) alone are no panacea to poverty alleviation but rather a blueprint. We contend that Sub-Sahara Africa’s problems transcend the simplistic development views of western epistemology. Rather they reflect the tension that exists between externally driven and/or imposed development agendas and the indigenous ways of social development. In addition, Sub-Sahara Africa’s development challenges are structurally induced. As such, achieving the MDGs will require a multifarious approach to addressing poverty.