This work is a political economic history that analyzes approximately 350 years of rivalry between traditional, Islamic, and European systems of health in the Senegambian region of West Africa. The work is divided into three parts. Part I focuses on the theoretical parameters of a political economy of health care. Part II addresses the historical nature of health care rivalries in the Senegambian region from the mid-seventeenth century through independence. And Part III looks at contemporary contention concerning health care delivery and the ways in which 'average' people craft alternative health care mechanisms while bringing pressure to bear on national and international bodies as well. A Political Economy of Health Care in Senegal should prove useful as a critical indicator of the ways in which historical agency is manifested historically and in contemporary health policy; policy that is often initiated outside of the "official" sector.