Health Care Financing Instruments during the Colonial Period in Senegal: The Historical and Institutional Nature of Policy Instruments
Abstract
There has been limited research on African policy instruments’ historical and institutional
nature in health policy literature. However, in the field of health systems research,
there are many examples that show the permanent use of financing instruments inspired
by liberal (pro-market) ideas such as user fees, performance bonuses, or private practice
of medicine in Africa. Through an analysis of archives (1840–1960), this article shows the
presence of these instruments in the health system during the French colonial period in
Senegal. Thus, this study shows that these financing policy instruments’ institutional
presence and longevity are part of a liberal approach that predates international organizations’
contemporary (and liberal) promotion. This study uses a historical and institutionalist
approach to understand the context, actors, and underlying factors that
allowed for this historical continuity, resulting in the permanence of these instruments