Ridde Valéry auteur aut IRD Diaw M. auteur aut IRD Béland D. auteur aut IRD text journalArticle eng text/pdf born digital access 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. specialized policy instruments history institutions health care financing Senegal colonial period SENEGAL 056 37 2 160-177 2025 0898-0306 https://www.documentation.ird.fr/hor/fdi:010092883 10.1017/s0898030624000034 0898-0306 [F B010092883] https://www.documentation.ird.fr/hor/fdi:010092883 https://www.documentation.ird.fr/intranet/publi/2025-04/010092883.pdf Accès réservé (Intranet de l'IRD) IRD - Base Horizon / Pleins textes 2025-04-02 2026-06-12 fdi:010092883 fre