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Tripwire Presents expands publishing business to support smaller indie developers
Tripwire Interactive's publishing division, Tripwire Presents, is expanding to offer publishing support to smaller inde…
How to correctly recycle your political yard signs in Omaha
Don’t just throw your political yard signs away now that election day has come and gone: make sure you recycle them correctly.
SIU to host November 13 small business workshop for military veterans
The workshop will also include networking opportunities and a panel discussion featuring experienced veteran business owners.
City of Independence to make recommendations on better supporting local businesses
The City of Independence hopes new policy changes will make it easier for small businesses to stay open, operate and grow.
Mad Science: Pickle-themed experiments
Radiant Randy with Mad Science of Greater Kansas City joins Shane and Guest Host Steve Serrano to show off a few pickle experiments.
Health inspector reports moldy food, roaches at Nashville restaurant
The future of a Nashville restaurant is in flux after health inspectors found moldy food, an active roach infestation, and beef left at room temperature on the floor.
Clemson University mourns death of alumnus, business school namesake Billy Powers
Clemson University is mourning the death of alumnus Wilbur O. “Billy” Powers, a philanthropist and namesake of the university’s business school. He was 90 years old.
Kansas just elected a Democrat. His message to Washington? Be decent
The Methodist pastor who flipped a Republican Senate seat says voters want more than political change. He tells NPR what he heard from Kansans about decency, faith and finding common ground.
Benson names business execs, community leaders to transition team
Business, union and community leaders will help shepherd Democratic Gov.-elect Jocelyn Benson's transition over the next few months.
Money out of Politics ballot measure faces First Amendment challenge
The Mackinac Center for Public Policy argues provisions of the proposal violate the First Amendment. It filed a federal lawsuit Wednesday.
CData Software Recognized as Challenger in Gartner's 2026 Magic Quadrant for Data Integration Tools
CData’s platform connects and governs access to hundreds of enterprise systems for people, applications and AI agents CHAPEL HILL, N.C., Nov. 4, 2026 — CData Software today announced that it has been positioned as a Challenger in the 2026 Gartner Magic Quadrant for Data Integration Tools. CData is the only vendor positioned in the Challenger […]
Phoenix business owner hosts shed giveaway for tornado victim
The owner of Shed Gal felt compelled to help out after seeing the devastation.
Prepping for business at The Honey Baked Ham Company
The Honey Baked Ham Company has options to help you prepare for holiday gatherings.
Mental health evaluation ordered for man accused in deadly shooting of North Royalton building commissioner
The man accused of fatally shooting the North Royalton building commissioner inside the service department, was ordered to undergo a mental health evaluation Wednesday.
Healthy Living with USA Health: Prostate Cancer
In this ‘Healthy Living with USA Health’, Dr. Tarek Lawen joins us with what you need to know about prostate cancer.
UMaine political science chair cites affordability, Trump in election results
WABI TV5 News at Noon
Married Entrepreneurs: Cris & Charmaine Eddings on Building Business
Cris and Charmaine Eddings are married entrepreneurs who came to business from very different directions.
Married Entrepreneurs: Cris & Charmaine Eddings on Building Business
Cris and Charmaine Eddings are married entrepreneurs who came to business from very different directions.
Phoenix business owner hosts shed giveaway for tornado victim
As residents in Heber-Overgaard continue cleanup, a local business owner is donating a storage shed to someone impacted by the tornado.
SIUC to host resource workshop for military veteran small business owners
Southern Illinois University Carbondale will host a resource workshop for military veteran small business owners and those wanting to start a small business.
Gaston County health official works to expand mental health resources for teens
Trey Sarter, mental health coordinator for Gaston County Public Health, is working to reach the county’s younger population, a group he said has become a top priority for local public health leaders.
Back in the majority, Democrats have plans for a long list of Trump investigations
Democrats will have the ability to subpoena records and compel individuals to testify. The Epstein files, Elon Musk, the Iran war and Trump's business interests may all come under the microscope.
God of War Laufey delayed three months to May 2027, as Sony Santa Monica escapes a packed February
God of War Laufey has been delayed to May 2027, moving out of a crowded February already filled with Fable, Persona 4 Revival and much more.
Science advocates react to Democrats' historic midterm rout: 'It's a new day in Washington'
Researchers and advocates say they hope the 'blue wave' could signal more accountability after two years of attacks on science
LeTourneau political science professor analyzes historic Texas election shift
Shift in Latino and suburban voters drives Democratic victories statewide, he said.
LeTourneau political science professor analyzes historic Texas election shift
Shift in Latino and suburban voters drives Democratic victories statewide, he said.
UMaine political science chair cites affordability, Trump in election results
University of Maine political science chair Mark Brewer said Wednesday that he and the rest of the nation witnessed a banner night for Democrats.
Incumbent DA reelected by 3 to 1 margin in Hancock County
Incumbent District 7 top prosecutor Bob Granger of East Blue Hill swept up nearly three times as many Hancock County votes as his challenger, Steven Juskewitch, a Dedham attorney, on
What science says about perimenopause, menopause and mood swings
The link between between this transition and mental health is real but more complicated than the ‘meno-boom’ suggests.
Sports figures-turned-politicians mixed results in midterm elections
Former athletes NFL linebacker Colin Allred, MLB slugger Mark Teixeira, and Paralympian Josh Turek are a few of the sports figures who participated in the midterm elections and won.
Science Central: Mixology
Kristen Peck, Marketing Manager, Science Central, talks about Mixology, an event for people 21+ years old, featuring a Whiskey Experience.
Harrison Ford to be recognized at the Paley Honors Fall Gala
The Paley Center for Media will celebrate Harrison Ford at its fall gala, alongside previously announced honorees Greg Berlanti, Goldie Hawn and Melissa McCarthy.
Hancock County votes In a new probate judge
There’s a new probate judge in town. Well, in Hancock County.
Tippecanoe health officials voice concern for measles cases across Indiana
Rising measles cases in Indiana are causing Tippecanoe County health officials to sound the alarm on preventive vaccines before the holidays.
Hannah Pingree wins governor’s race
Democrat and former Maine House speaker Hannah Pingree has won the gubernatorial election, beating out her Republican adversary Bobby Charles and Independent Rick Bennett.
Cuyahoga County’s health and human services levy passes
Voters went to the polls and approved Issue 11, a levy for the Cuyahoga County Department of Health that sought to increase funding to keep essential services running.
Palm Beach County students help scientists track where trash drifts in local waterways
Shining A Light on Palm Beach and the Treasure Coast
Election 2026: Nebraska voters reject ballot measures to legalize online sports betting
Nebraska voters have rejected a pair of ballot initiatives that sought to legalize and regulate online sports betting.
What a blue wave means for North Carolina. Reporters, political watchers join Due South for post-election analysis
Due South’s Jeff Tiberii and a panel of reporters and political scientists dig into the election results and what they mean for our state and our country.
The Donald Trump Era in American Politics Is Ending
The takeaways from the midterms are clear: no amount of billionaire spending could overcome the fact that Donald Trump’s dominance is coming to a close, the Left has much more room to grow, and we have entered a period of new possibility in US politics.
This Week In Politics: G20 Foreign Ministers’ Meeting
Amid national divides over the upcoming midterm elections, international friction also surfaced at the Group of Twenty’s (G20) foreign ministers’ meeting in Atlanta, Georgia, on Friday, Oct. 30, and Saturday, Oct. 31. Top diplomats from the G20, an international forum comprising the world’s largest economies that convene to address global economic policy and development, gathered...
Aroma Joe's now open in Bucksport
Aroma Joe's has opened its new location, its 58th in Maine, at 80 US-1 in Bucksport. The newly built, 1,170-square-foot coffeehouse and drive-thru features coffee and espresso drinks, flavor infusions,
INTERVIEW: WEAU Political Analyst John Frank discusses results of midterm election
Hello Wisconsin’s Bob Gallaher sat down with WEAU Political Analyst John Frank.
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
One of Nintendo's Switch and Switch 2 cartridge manufacturers is exiting the business, which could make physical games more expensive
Macronix, one of the companies that create components in Switch and Switch 2 cartridges, is calling it quits.
USC political science expert breaks down S.C. elections
South Carolina voters reshaped the state’s political landscape Tuesday night.
From science experiments to “exploration at scale”
Panellists from State Street, SIX, Standard Chartered, Calastone and BNP Paribas explain why the industry is moving to tokenisation, and take stock of regulation, technology and infrastructure. Regulators are now a springboard for growth, but client interest still isn’t turning into live products. What’s missing is a use case that pays for itself quickly.
Moderate drinking carries health risks even within UK alcohol guidelines
A new study estimates the lifetime risks of drinking alcohol and explains why staying within the UK’s 14-unit weekly limit doesn’t guarantee safety.
HOMETOWN HEALTH: Cannabis involved in most substance-related ER visits for teens, study finds
Cannabis-related emergency room visits also are rising among adults ages 19 to 24.
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
Michigan votes in favor of Proposal 2 to get ‘Money Out of Politics,’ AP projects
Michigan voters have voted in favor of Proposal 2, which aims to “get money out of politics.”
St. Monica High reaches flag football final in inaugural season
St. Monica put together its girls' flag football program for this season and they'll be playing for the Southern Section Division 6 championship.
Why Nintendo is betting on a nearly 30-year-old game remake to win the holiday
“Saturday Night Live” poked fun at characters from two of the holiday season’s most anticipated video game releases last month: Link from the upcoming remake of “The Legend of Zelda: Ocarina of Time” and Jason from “Grand Theft Auto VI.”
Council to consider entertainment director hire for amphitheater
The city council is considering hiring a director of entertainment for the Sen. Terry Brown Amphitheater on the Island ahead of its completion.
Trump has defied political consequences for years. The midterms changed that
The elections were a categorical repudiation of a Republican president who has spent the first half of his second term governing without regard to consequences.
'Richard Avedon: Hollywood' is now on view at Gagosian in L.A.
A new exhibit at Gagosian, 'Richard Avedon: Hollywood,' features more than 120 images, spanning from 1947 to the year Avedon died in 2004.
Marc Maron is figuring out what to do with all his free time
After ending ‘WTF With Marc Maron,’ the comedian is embracing privacy, pursuing new projects and figuring out life beyond the microphone.
Outback franchisee files for bankruptcy, citing California labor costs
San Diego-based Cerca Trova Restaurant Group, which once operated nearly 100 Outback Steakhouse restaurants, filed for Chapter 11 bankruptcy on Monday.
Terry Pluto on Cleveland sports TV 'chaos': Where did the games go?
Ideastream sports commentator Terry Pluto explains how shifting broadcast deals and streaming services are creating chaos for Cleveland sports fans trying to watch the Cavs and Guardians.
Dragon's Dogma 2 gets a timed collaboration with beloved anime and manga series Delicious in Dungeon, and it's out right now on PC, PlayStation and Xbox
The Dragon's Dogma 2: Dark Arisen collaboration brings in new allies and equipment for a limited time.
'Chef's Kiss' reopens as a new Topeka catering business
Topeka chef Kelli Page is launching a new catering and events business after closing her restaurant for health.
Expecting a new grandchild? Here’s why you may need to see your doctor first
When a baby is on the way, doctors often recommend that the mother get certain vaccinations to protect her newborn – and it turns out that other family members who may visit the infant, especially grandparents, are urged to be up to date on certain shots, too.
A year after UPS plane crash, South End business owners struggle to stay afloat
Near the site of the fatal UPS plane crash in Louisville, some of the area is still closed to vehicular traffic. Business owners there have struggled to pick up the pieces.
These 9 candidates for governor just made history
Voters on Tuesday elected the nation's first Black woman governor and the nation's first Native American woman governor.
FBI arrests Oklahoma man for mailing hundreds of threats to political officials ahead of midterms
FBI agents have arrested an Oklahoma man in connection to hundreds of threatening messages to political and public officials sent in the mail.
Watch CNN’s coverage of Election Night in 5 minutes
The 2026 midterms results have revealed a blue tsunami as Democrats take back control of Congress. CNN’s coverage over the night highlights the stunning turn of the tides for Donald Trump’s Republican Party.
Democratic candidates Acton, Brown win on historic night in Ohio politics
Voters selected in the first woman to be elected governor in Ohio and returned former U.S. Sen. Sherrod Brown to Washington.
Troy Jackson topples Republican Susan Collins in Maine Senate race
Democrat Troy Jackson defeated five-term Republican Sen. Susan Collins in Maine, despite only becoming his party’s nominee in July.
Ubisoft reportedly seeking to acquire Arkane Lyon from Xbox
Reports suggest Ubisoft is one of three companies looking to buy studio following extension of consultation period
Texas Democrats pull off the breakthrough they’ve chased for decades
For decades, Texas Democrats have dreamt of turning the state blue, rallying around exciting candidates who drew big crowds and big money but could not ultimately overcome the state’s stubborn conservative majority.
Democrat Abdul El-Sayed projected to win Michigan and become nation’s first Muslim senator
What’s next after Trump’s massive miscalculation triggers historic defeat
There’s only way to view the Democrats’ staggering midterm election triumph: It is one of the most colossal repudiations of a sitting president in modern history.
Democrats secure historic majorities in the midterms — and are poised to win even more seats
The party is poised to have strong majorities in Congress for the final two years of President Trump’s term. Follow for live updates.
Michigan's 'money out of politics' measure passes, faces legal challenge
Unofficial results from the New York Times show Proposal 2 received support from 81% of Michigan voters.
Trump reacts to Republican losses and declines to take blame
By the time the House and Senate had been called for Democrats on Tuesday, a consensus among members of both parties was forming: voters had rejected President Donald Trump’s record in office, and he would face a starkly different political reality for the remainder of his term.
Nebraska football’s special teams search for consistency as kicking woes persist
A major talking point with Nebraska football is a lack of consistency on special teams. These failures have led to Matt Rhule replacing Kyle Cunanan with Matt Hohl for all field goals and points after touchdowns.
Nebraska men’s golf fall season recap
Sports writer Connor Krumme describes the many highs and lows that have occurred throughout the Huskers’ latest golf season.
Political analysts discuss Wisconsin governor's race results
Democrat David Crowley defeated a Republican with close ties to President Donald Trump on Tuesday, rising from a childhood in one of the nation’s poorest neighborhoods to become the first Black person to lead the battleground state.
The historic firsts of the 2026 election
Winners up and down the 2026 ballot will make history this year, CNN’s Decision Desk projects, including the first Black woman governor and the first out gay male US senator.
Amy Acton reflects on her childhood in acceptance speech
Democrat Amy Acton reflected on her journey from childhood homelessness to becoming a doctor and now projected as Ohio’s next governor as she celebrated her win over Republican Vivek Ramaswamy. The former state health director will become the first woman elected governor of Ohio and the first Democrat to win the office since 2006.
Texas Politics Enter a New Era After Hinojosa's Win
Texas State Rep. Gina Hinojosa won the race for governor, the first Democrat to win the office since 1990. She beat incumbent Greg Abbott, who was seeking a fourth term.
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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