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Published online by Cambridge University Press: 10 March 2025
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.
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