Science and innovation do not thrive in undemocratic societies (see Donors 'must invest' in poor nation health systems). A buoyant healthcare system depends on good pharmaceutical research and a people-centred system of health education, training and delivery. Thus, health policies in poor countries are doomed because of failing democracies and the selfish interests and influence of developing country donors in pharmaceutical research and in the medicare system of poor countries.

When donors and wealthy industrialists insist on patent protection, for example, they only protect their interests and impede the access of poor countries to medicines. Thus, the function of intellectual property protection is to dissuade the international pharmaceutical industry from investing in research and treatment of diseases that keep poor people poor and in the health threats to the poor such as malaria, tuberculosis, HIV/AIDS, maternal deaths and high infant mortality.

The absence of strategic planning and visionary management in African countries is a major cause of ineffective donor assistance and development aid in all sectors, particularly health and agriculture.

Until resource-poor countries and undemocratic regimes make a commitment to aggressively enforce accountability and transparency in their relations with their people and donor agencies, development assistance in poor countries will remain a forlorn hope. This probability is fuelled in this neo-liberal globalisation era because the struggle for economic power and control over technology are the primary goals of multinationals and rich nations.

Political instability also has a critical impact on health policies in poor countries. When politicians are accustomed to practise their art on a paper plate, they are less likely to negotiate long-lasting and effective policies with donors who may return only after their exit from political power. The option? Go with the donor's wishes in order to satisfy the whims and caprices of what Cameroonians refer to as "stomach politics" before time runs out.

"The 3Cs — coordination, coherence and complementarity — are the core principles for the development cooperation of the European Union and its member states". It is hard to say that these principles hold sway in the health sector policies in developing countries. Donor agencies deliberately refuse to coordinate their efforts with others on the ground, ignore the coherence of their actions with the canker of Africa in the development race — poverty — and fail to work with civil society in a complementary manner to achieve the Millennium Development Goals. 

The result is that the poor will remain poor because development agencies and developing country governments obfuscate the wisdom of marrying agricultural and health policies, except where their direct or indirect interests are threatened.

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