Ridde Valéry auteur aut IRD Caffin J. H. auteur aut IRD Hane F. auteur aut IRD text journalArticle eng text/pdf reformatted digital access Senegal has long sought solutions to achieve universal health coverage (UHC). However, in a context dependent on international aid, the country faces multiple external pressures to choose policy instruments. In this commentary, we propose an analysis of this influence. The empirical material comes from our involvement in analysing health reforms for 20 years and from many interviews and observations. While studies have shown that community-based health insurance (CBHI) was not an appropriate solution for UHC, some international actors have influenced their continued application. Another global partner proposed an alternative (professional and departmental CBHI), which was counteracted and delayed. These issues of powers and influences of international and national consultants, established in a neo-liberal approach to health, have lost at least a decade from UHC in Senegal. The alternative now appears to be acquired and is scaling up at the country level, witnessing a change in the current policy paradigm. specialized Universal health coverage policy instrument Senegal Paris Declaration ownership SENEGAL 056 39 1 80-83 2024 0268-1080 https://www.documentation.ird.fr/hor/fdi:010088745 10.1093/heapol/czad108 0268-1080 [F B010088745] https://www.documentation.ird.fr/hor/fdi:010088745 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2024-01/010088745.pdf IRD - Base Horizon / Pleins textes 2024-01-12 2026-06-12 fdi:010088745 fre