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Communist Party Politics, Rockets and Komsomol Business in Soviet Dnipropetrovsk
This is an excerpt from Ukraine’s Outpost: Dnipropetrovsk and the Russian-Ukrainian War (2022). Free to download from E-International Relations. The Ukrainian city of Dnipropetrovsk (in 2016 the city was renamed Dnipro) was shown on a movie screen in the Soviet Union for the first time in 1981 as a ‘Russian-speaking’ city in Nikita Mikhalkov’s feature film Rodnia. A story of a Russian peasant woman who visited her daughter in the big industrial city was used by Mikhalkov in his movie to emphasise a growing crisis in Soviet family life during the Brezhnev era when former Russian peasants lost their Orthodox Christian identity during the process of socialist industrialisation and modernisation. Paradoxically, Mikhalkov completely ignored the real social and national problems of the city; instead choosing as the setting for his movie Russian peasants’ adjustment to Soviet modernisation. Even now many Russians use this film as evidence of the ‘Russian character’ of Dnipropetrovsk ignoring the real demographic and social history of this Ukrainian region (Elberg-Wilson 2016).[1] Despite Mikhalkov’s picture, the city of Dnipro and the Dnipropetrovsk region had a multi-national and multi-cultural character coupled with the strong influence of Ukrainian and Jewish culture. Get E-International Relations delivered to your inbox, free. As you sign up, consider becoming a paid subscriber, or make a donation, to support our work. Subscribe Using various archival and published documents, this chapter will cover the social, economic and cultural development of the city and the region of Dnipropetrovsk through the period of late socialism after Stalin, showing the ties between the multi-national Komsomol members and business ventures during perestroika and how this influenced the rise of oligarchic clans in post-Soviet Ukraine. Emergence of Soviet Dnipropetrovsk Paradoxically, from the early beginning, the founding of the ‘city of Catherine’s glory’ (Ekaterinoslav in Russian) and its province in 1776 by the Russian imperial administration of the Catherine the Second involved non-Russian ethnic groups, which shaped a historical demography of this region in Southern Ukraine. These ethnic groups included the local Ukrainian Orthodox Christian peasants and Cossacks, Jewish traders and artisans, Armenian Christians, and Tatar Muslim settlers. By the middle of the nineteenth century, thousands of German Protestant and Mennonite colonists also settled in the province. Moreover, by attracting foreign capital, the Russian imperial administration transformed this multi-ethnic and multi-religious region in the booming industrial centre of the Russian Empire by the beginning of twentieth century (Zhuk 2004, 33–96). After the Russian Revolution and civil war, the province of Ekaterinoslav continued to play an important role in the industrial development of the Ukrainian Soviet Socialist Republic. In 1926 the Soviet administration decided to change the name of Ekaterinoslav which sounded too ‘old fashioned’ and ‘imperial Russian.’ The new name was a combination of the name of the Dnipro River with the last name of Grigorii Petrovskii, head of the All-Ukrainian Executive Committee of the Soviets, and well-known organiser of the working-class movement in the region of Ekaterinoslav before the Revolution. ‘Dnipro-Petrovske’ was later transformed into ‘Dnipropetrovsk’ (Bolebrukh 2001, 156). Both the city and region of Dnipropetrovsk lived through the New Economic Policy (N.E.P.), industrialisation and the Stakhanovite movement. The region lost millions of human lives during collectivisation and the dekulakisation campaign, and especially during the Holodomor of 1932–33. During industrialisation, the Soviet government restored the industrial base of the region. Former metallurgical giants such as the Petrovskii (formerly Brianskii)plant, the Chodoir (formerly Vladimir Lenin) plant and others resumed production of pig iron and steel. During the 1930s, Dnipropetrovsk became an important centre for Soviet heavy industry. In 1932, Dnipropetrovsk regional metallurgical plants produced 20 per cent of the entire cast iron and 25 per cent of the steel manufactured in the Soviet Ukrainian Republic. After the beginning of the campaign of ‘Ukrainianisation’ in 1923, the number of those who spoke Ukrainian grew, reaching 38.5 per cent in the city by the end of the 1920s. Between 1932 and 1939, the number of city dwellers in Dnipropetrovsk increased to over 500,662. The Dnipropetrovsk region became the most urbanised of Soviet Ukraine with more than 2,273,000 people living in the region (Vasiliev 1977, 55; Bolebrukh 2001, 159–164). Dnipropetrovsk also became the cultural and educational centre of Soviet Ukraine. There were ten colleges, including the State University, 97 secondary schools and 19 vocational schools. The Soviet administration restored local drama and music theatres. During the 1930s, Dnipropetrovsk had 120 libraries, five museums, six movie-theatres, 30 clubs and palaces of culture (Bolebrukh 2001_,_159–164). The Leonid Brezhnev Clan Post-war Soviet modernisation influenced the careers of many young and ambitious Komsomol members in the region. One of them, Leonid Brezhnev, was born in 1906 in Kamenskoe, joined the Kommunystycheskaya Partyya Sovetskoho Soyuza (Communist party of the Soviet Union - KPSS) in 1931 and, after graduation from Dniprodzerzhinsk Metallurgical Institute was elected as a council deputy of the city of Dniprodzerzhinsk. The Stalinist purges of the 1930s removed many old Soviet and Communist officials from government positions who perished in prisons and the labour camps of GULAG. Young people such as Brezhnev filled the void created by Stalinist repressions in the region. In 1938, the young Brezhnev was elected as a member of the regional committee of the Soviet Communist party of Ukraine (KPU) and head of the Department of Agitation and Propaganda. By the young age of 32, Brezhnev had become secretary of the KPU committee of the most important industrial region of Soviet Ukraine. His career was interrupted by the Great Patriotic War when Brezhnev joined the army as an ideological officer (see Mlechin 2005). From August 1941 to October 1943, the Dnipropetrovsk region was occupied by the Nazis, and Soviet troops liberated the entire region by February 1944 (Berkhoff 2004, 11, 36, 49, 149–150, 152–153, 248–249). The Soviet administration restored the industrial base of Dnipropetrovsk, and by 1950 the main metallurgical and machine-building factories had reached their pre-war levels of industrial production and productivity. During this period, Brezhnev began his political career as a talented and ambitious organizer of the industrial re-birth of Dnipropetrovsk. He was an experienced young army ideologist who had proved his loyalty to the Stalinist leadership during the war and was familiar with Dnipropetrovsk before 1941. The Central Committee of the KPSS sent Brezhnev to Dnipropetrovsk in November 1947 when he was elected first secretary of the Dnipropetrovsk regional committee of the KPU, and he ruled the oblast until June 1950 (Vosstanovlenie). His successors were Andrei Kirilenko and Volodymyr Shcherbitskyy, both close friends. Two other young comrades of Brezhnev, Oleksiy Vatchenko and Yevhen Kachalovskii led the region respectively in 1965–1976 and 1976–1983 (Vasiliev 1977, 72; Bolebrukh 2001_,_ 233; Mlechin 2005). Brezhnev promoted the political career of his old friends, many of whom became prominent political figures in Kyiv and Moscow during his leadership of the KPSS. Both contemporaries and scholars who study the ‘Brezhnev period’ call this phenomenon the ‘Dnipropetrovsk mafia’ or rule of the ‘Dnipropetrovsk Family’ (Nahaylo 1999, 36, 69; Wilson 2000, 162). Since the rise of Brezhnev to the pinnacle of Soviet power, the ruling elites of Dnipropetrovsk influenced not only regional, but also republican and All-Union politics. Dnipropetrovsk’s transformation into an important centre of the Soviet military industrial complex was directly related to the sudden rise of Brezhnev to the pinnacle of Soviet power in October of 1964. Brezhnev promoted the political career of his compatriots from the Dnipropetrovsk military industrial complex. Brezhnev’s friends and close colleagues from his post-war years in the Dnipropetrovsk region went to Moscow and became prominent political figures in the Soviet nomenklatura hierarchy during the 1960s and 1970s. Two main industries of the Soviet military industrial complex – metallurgy and missile-building – had important factories in Dnipropetrovsk and therefore provided the Brezhnev clan with new members from 1964 until 1982. Even after the downfall of the Brezhnev clan in Moscow in 1983, when Yurii Andropov began his struggle ‘against corruption and nepotism’ in the Soviet nomenklatura, members of this clan continued to play a prominent role in the political life of Soviet Ukraine. Besides the Physical-Technical Department of Dnipropetrovsk State University, the Dnipropetrovsk Metallurgical Institute also assisted the political careers of many of Brezhnev’s close friends who in the 1970s and 1980s became important members of the Kremlin nomenklatura. Nikolai Tikhonov, former head of Dnipropetrovsk Sovnarkhoz during the 1950s, was one of the deputies of the Soviet Prime Minister between 1966 and 1976, First Deputy of the Prime Minister from 1976 to 1980 and head of the USSR Council of Ministers from 1980 to 1985.[2] Nikolai Shcholokov was the Soviet Minister of Public Order in 1966–1968 and from 1968 to 1982 he was Soviet Minister of Interior. Georgii Tsynev was during 1971–1976 a member of the Central Revision Committee of the KPSS and a deputy head of the KGB from 1970 to 1982. In the KGB he was the 1st Deputy Chairman in 1982–1985 as well as he was a Candidate Member of CPSU Central Committee in 1976–1981 and accordingly was a full Member of the said body in 1981–1986. Victor Chebrikov, who graduated from Dnipropetrovsk Metallurgical Institute in 1950, was one of the leaders of the city party organisation in Dnipropetrovsk from 1961 to 1971. In 1971 he became the head of the personnel department of the USSR KGB, First Deputy of the Head of this organization and from 1982 to 1988 a chairman of the KGB (Pikhovshek 1996, 11–12, 272–274). Another of Brezhnev’s close friends, Volodymyr Shcherbytskyy, promoted the careers of other people from the region of Dnipropetrovsk. With his support, Oleksii Vatchenko became the head of the Presidium of the Ukrainian Soviet Supreme Soviet from 1976 until 1984 with the assistance of another politician from Dnipropetrovsk, Valentyna Shevchenko. Aleksandr Kapto, who worked as a secretary of both the Dnipropetrovsk Komsomol organization and the Soviet Ukrainian Komsomol in Kyiv in the 1960s, oversaw the Department of Culture in the Central Committee of the KPU; in 1979–1986 he was a Secretary of the Central Committee and accordingly was the main ideologist of the Soviet Ukraine. Many other members of the ‘Kyiv ruling class’ under Shcherbytskyy were also linked to the Dnipropetrovsk metallurgical and military lobby. Shcherbytskyy’s assistant from 1972 to 1984 was Konstantin Prodan who began his career in the Komsomol organisation of the city of Dnipropetrovsk (Pikhovshek 1996, 48–103). As a contemporary political analyst noted, ‘Officially Prodan was put in charge of industrial production, though, according to insiders of the former KPU Central Committee, his principal function was ‘maintaining’ contact with Brezhnev’s assistant Georgii Tsukanov in Moscow’ (Pikhovshek 1996, 33–34). Another important reason for the rise of the ‘Brezhnev Clan’ was the relative independence of Dnipropetrovsk’s local administration from Kyiv. Because of the status of Dnipropetrovsk as a ‘strategically important centre for military industry,’ different branches of the local administration were under the direct supervision of Moscow, rather than Kyiv (Interviews with Tihipko, Markov and Bocharova). The Military Industrial Complex and Ruling Elite of Dnipropetrovsk The city of Dnipropetrovsk was the location of famous metallurgical and machine-building factories in pre-revolutionary Russia and the Soviet Union. Before 1941, Dnipropetrovsk became the most urbanised region of the Soviet Ukraine. Almost 53 per cent of this region’s population lived in 16 cities and towns of the region (Vasiliev 1977, 55; Bolebrukh 2001, 159–164). In 1980, the industrial enterprises of Dnipropetrovsk manufactured a significant part of the industrial products and customer goods for the Soviet Ukrainian Republic. A total of 5.4 per cent of steel, 9 per cent of rolled iron, 28 per cent of pipes, 62 per cent of combine beet-harvesters, 27.9 per cent of television sets, and 8.5 per cent of knitted wear in Ukraine were produced in the city of Dnipropetrovsk (Bolebrukh 2001, 219). After 1945, the main centre of economic and financial activities of the region and the city of Dnipropetrovsk became neither metallurgy nor mining. The new centre which changed the status of the region and of the city was a secret military factory in Dnipropetrovsk. The entire ideological and cultural situation in the region, and especially the city, depended on this one industrial plant which became the most important part of the Soviet military industrial complex. In July 1944, the State Committee of Defence in Moscow decided to build a large military machine-building factory in Dnipropetrovsk on the location of the pre-war aircraft plant. In December 1945, thousands of German prisoners of war began construction and built the first sections and shops of the new Dnipropetrovsk Automobile Factory (Markov, 1995). In 1947–1948 this factory produced its first cars and special military vehicles. However, on 9 May 1951 the USSR Council of Ministers decided to transform the main shops and sectors of this factory into ‘secret production’ which included not only special military vehicles, but also powerful rocket engines and different types of modern military aircraft. The former Dnipropetrovsk Automobile Factory was transferred to the Ministry of Armament of the USSR and received a new name – the State Union Plant #586 (Lukanov 1996, 12). Stalin introduced the organisation of special secret training of highly qualified engineers and scientists who were to become rocket construction specialists. He recommended the introduction of a new college degree at Dnipropetrovsk State University which would be a Master of Sciences in rocket construction. In 1952 the university administration formed a new department with the name ‘physical-technical faculty’ which was the largest department at the university, admitting on average four hundred students each year. These students received better accommodation and a higher stipend payment than students from other departments and colleges; the lowest stipend for this department was 450 roubles, while the highest stipend at another prestigious school, the Dnipropetrovsk Medical Institute, was only 180 roubles. A special commission from Moscow selected talented undergraduate students studying physics from engineering schools all over the USSR and sent them to the physical-technical department at Dnipropetrovsk State University, where they resumed their studies as rocket engineers. Simultaneously, the university administration announced the admission of new freshmen students in this department. The promise of a good stipend and a ‘romantic’ career of rocket engineer attracted thousands of talented young people to this ‘secret’ department, which provided training specialists for only the Dnipropetrovsk Automobile Factory (Horbulin 1998, 9, 62–63). In accordance with another decision of the Soviet government, in 1954 the administration of this automobile factory opened a secret design office with the name ‘Southern Construction Bureau’ (konstruktorskoe biuro Yuzhnoe). The main assignment of this office was to construct military missiles and rocket engines. Hundreds of talented physicists, engineers and machine designers moved from Moscow and other big cities in the Soviet Union to Dnipropetrovsk where they joined the konstruktorskoe biuro Yuzhnoe (KBYu). In 1965, the secret Plant #586 was transferred to the Ministry of General Machine-Building of the USSR and the next year it changed its name into the ‘Southern Machine-building Factory’ (Yuzhnyi mashino-stroitelnyi zavod) or simply Yuzhmash (in Ukrainian Pivdenmash). The first ‘General Constructor’ and head of the ‘Southern’ design office was Mikhail Yangel, a prominent scientist and outstanding designer of space rockets who led the design office and factory from 1954 to 1971. Yangel designed the first powerful rockets and space military equipment for the Soviet Ministry of Defence. Yangel worked with talented engineers who later became the leaders of military production in Dnipropetrovsk and the official directors of Pivdenmash. Two close collaborators of Yangel were the Pivdenmash directors Leonid Smirnov (1952–1961) and Aleksandr Makarov (1961–1986). Makarov’s successor was Leonid Kuchma, the Director General of the Pivdenmash in 1986–1992, who later became one of the most prominent political leaders in independent Ukraine and was and still is the only President of Ukraine (1994–2005) elected twice (Strazheva; Platonov and Horbulin; Romanov and Gubarev; Baikonur; Baikonur, Korolev, Yangel). In 1951 the Southern Machine-building Factory began manufacturing and testing new military rockets with an initial range of only 270 kilometres. By 1959 Soviet scientists and engineers developed new technologies, and as a result, the KBYu launched a new machine-building project producing ballistic missiles. Under Yangel, KBYu produced very powerful rocket engines which dramatically increased the range of ballistic missiles and from the 1960s, began to be used as launch vehicles for Soviet spaceships. Pivdenmash designed and manufactured four generations of missile complexes which included space launch vehicles Kosmos, Interkosmos, Tsyklon-2, Tsyklon-3 and Zenith. The KBYu created a unique space-rocket system called Energia-Buran and manufactured 400 technical devices which were launched as artificial satellites (Sputniks). For the first time in the world space industry, the Dnipropetrovsk missile plant produced space Sputniks. By the 1980s, Pivdenmash manufactured 67 different types of spaceships, 12 space research complexes and four defence space rocket systems. These systems were used not only for purely military purposes by the Ministry of Defence, but also for astronomical research, for global radio and television and for environmental monitoring. Pivdenmash initiated and sponsored the international space programme of Eastern European socialist countries, called Interkosmos. Twenty-two of the 25 automatic space Sputniks of this programme were designed, manufactured, and launched by engineers and workers from Dnipropetrovsk. Pivdenmash and KBYu became not only an important centre of the Soviet space industry and Soviet military industrial complex, but also the main rocket producer for the entire Soviet bloc. (Hall and Shayler 2001, 316ff; Siddiqi 2003, 97, 113, 114, 164, 177, 285) The military rocket systems manufactured in Dnipropetrovsk created the base for the Soviet Strategic Missile Forces (Dnepropetrovskii raketno 1994; Bolebrukh 2001_,_ 209–211, 229; Lukanov 1996, 13). On the eve of the disintegration of the Soviet Union, KBYu had nine regular and corresponding members of the Soviet Academy of Sciences, 33 full professors and 290 scientists holding a Ph.D. More than 50,000 people worked at Pivdenmash. Pivdenmash was ‘a state’ inside the Soviet state. In 1969, after a long competition with Moscow’s V. Chelomei Centre of Rocket Construction, Pivdenmash rocket designs won, and from then leaders of the Soviet military industrial complex preferred only Pivdenmash models. The Soviet state provided billions of Soviet roubles to finance Pivdenmash projects (Horbulin 1998, 6, 24–31). Officially, Pivdenmash also manufactured agricultural tractors and special kitchen equipment for everyday needs, such as mincing machines or juicers for Soviet households. In official reports and public information there were no details given about its production of rockets or spaceships. However, hundreds of thousands of workers and engineers in the city of Dnipropetrovsk were employees of this plant, and members of their families and therefore most local people knew about the ‘real production’ of Pivdenmash. Dnipropetrovsk as a KGB “Testing Ground” The Soviet government approved the KGB’s proposal to introduce the highest level of secrecy over Pivdenmash and its products. According to the Soviet government’s decision, the city of Dnipropetrovsk was officially closed to foreign visitors in 1959. No citizen of a foreign country (even Eastern European socialist) was allowed to visit the city or district of Dnipropetrovsk. From the late 1950s, Soviet people called Dnipropetrovsk ‘the rocket city’ or ‘closed city.’ (Bolebrukh 2001, 211). Members of the Brezhnev clan in the Moscow offices of the KGB and Ministry of Interior also contributed to centralised ideological control in Dnipropetrovsk, which especially influenced the KGB and security operations in the closed city. The local KGB office was always more Moscow-oriented, ignoring the interests of the authorities in Kyiv. At the same time, for Moscow officials who began their careers in Dnipropetrovsk, the city became the testing ground for many All-Union KGB campaigns which they attempted to initiate. Dnipropetrovsk KGB officers were ‘pioneers’ in the organisation of ideological campaigns which became ‘models’ for other ‘closed’ industrial Soviet cities. [This phrase – ‘pioneers of ideological campaigns’ – belongs to a local retired KGB officer. According to the KGB documents, Moscow’s representatives in the Dnipropetrovsk clan always interfered in local KGB business, imposing their own practices on the local officers.] (Igor T.; DADO, f. 19, op. 52, spr. 72, ark. 1–18) As a result, the inhabitants of Dnipropetrovsk experienced more ideological limitations and more brutal anti-Western campaigns than people in many other Soviet cities. Facing direct Kremlin supervision, the local KGB and KPSS ideologists sought to prove their ideological reliability and occasionally exaggerated the ‘threat from the capitalist West.’ KGB officers transformed one building in the Dnipropetrovsk Special Psychiatric Hospital (psikhushka), located in a town of Ihren (now a suburban district of Dnipro), into a special police facility for ‘political dissidents.’ All over the Soviet Union, Ihren psikhushka (especially its Section 9) became notorious and known as the worst incarceration for political prisoners. The Dnipropetrovsk KGB tested various drugs on prisoners and performed different medical experiments, treating the most ‘opinionated’ political dissidents as mentally sick patients. Many religious and civil rights activists and ‘bourgeois nationalists,’ such as national communist dissident Leonid Plyushch, described the Dnipropetrovsk Psychiatric Hospital as ‘mental hell’ because of its police system of harsh treatment and everyday humiliation (Plyushch 1979, 304–326, 340–349). Meanwhile, local KGB officers explained their harsh treatment of dissidents such as Plyushch as an ideological necessity to protect a strategically important centre of the Soviet military industrial complex (Igor T). Growth of the Population and Standards of Living in the Region The new status of the city brought more state investments and contributed to the overall improvement of the standard of living of its inhabitants. During the 1950s, the main sponsor of city improvements and renovations was the metallurgical industry. During the 1960s and 1970s, the space rocket industry and its biggest factory, Pivdenmash, sponsored all major city programmes, renovations and new architectural projects which included the sports palace Meteor with a large indoor pool, football team Dnipro, city airport, city theatre of opera and ballet, historical museum of Yavornitskii, department store ‘Children’s World,’ construction of thousands of modern apartments, libraries and movie-theatres, and celebrations of the 200th anniversary of the city of Dnipropetrovsk in 1976. (Bolebrukh 2001_,_ 211–212). Even the expansion and renovation of the Dnipropetrovsk Central Farmer Market (known as Oziorka) was supported by Pivdenmash as part of its improvement of the city’s life, and a reflection of the growth and strategic importance of the city. From 1958 to 1965 the city administration invested money in building a new covered location for the market and by 1970 they had re-built the entire neighbourhood transforming it into a modern and convenient place for the ‘socialist consumption of goods and services.’ (Lazebnik 2001, 167–185) As a result, the missile factory, the centre of the Soviet military industrial complex, contributed to a new level of cultural consumption among not only the city’s dwellers, but also among all guests of Dnipropetrovsk. Consequently, the pioneering efforts in the popularisation of new modern forms of Western music such as jazz and rock-n-roll also began among engineers and workers of Pivdenmash who contributed to the spread of new cultural forms and activities among those who lived in the city and region of Dnipropetrovsk. The improving living conditions in Dnipropetrovsk led to an increase of the regional population from 2,339,800 people (with a 56 per cent urban population) in 1951 to 2,850,700 (with a 72 per cent urban population) in 1961. The larger salaries and better distribution of food and industrial goods also attracted young people from other regions of the Soviet Union to Dnipropetrovsk. From the 1950s onward, most of the Dnipropetrovsk population were people younger than 30 years old. In 1970 there were 3,343,000 people in the region (76 per cent of who lived in cities) which by 1984 had increased to 3,771,200 people (with 83 per cent urban population). The population of the city of Dnipropetrovsk grew from 660,800 people in 1959 to 1,066,000 in 1979 and more than 1,153,400 people in 1985 when Gorbachev came to power (Glushkina 1985, 10, 11). The Dnipropetrovsk region had a young multinational, predominantly Russian speaking population. Three major ethnic groups shaped the cultural development of the region – Ukrainians, Russians, and Jews. During the peak of ‘international harmony and prosperity of developed socialism’ in 1979, Ukrainians made up the overwhelming majority of the regional (72.8 per cent) and urban (68.5 per cent) population. Due to massive emigration from the Soviet Union, the Jewish population decreased from 2.7 per cent in 1959 to 1.7 per cent in 1979 and 1.3 per cent in 1989. The number of Russians in the region’s population grew rapidly from 17.2 per cent in 1959, 20.9 per cent in 1970, 23 per cent in 1979 and 24.2 per cent in 1989 (O vozrastnoi structure 1971; Goskomstat USSR 1991, 100, 102). By 1985, more than a third of the population in the city of Dnipropetrovsk was ethnically Russian. If we add to this number the 3.2 per cent of Russian-speaking Jews and more than 33 per cent of Ukrainians who considered Russian their native language, we will have more than two thirds of the city’s population who associated themselves with Russian rather than with Ukrainian culture. According to contemporaries, the high salaries and better conditions of living attracted representatives of various nationalities from different republics who also spoke Russian rather than the Ukrainian language in Dnipropetrovsk (Goskomstat USSR 1991, 106, 108, 119, 122; Prudchenko and Smolenska 2007). Komsomol ‘Business’ During the Late Soviet Era The regional economic activities of local ‘businessmen and women’ from the Komsomol during perestroika had their roots in the pre-perestroika era. They also strengthened trends for independence from Moscow which had earlier existed in Dnipropetrovsk. All the elements of their initial business had already been developed during the Brezhnev era when the cultural consumption of late socialism combined the structures of Soviet international tourism with the ideological efforts of Komsomol activists into one business network. Mass rock and discotheque music consumption among Soviet youth was delivered by Komsomol and trade union apparatchiks. International tourism and discotheque enthusiasts provided these apparatchiks with music and video material for their entertainment business. Without these relations it would be impossible to imagine the development of post-Soviet capitalism. The first pioneers of organizing Komsomol business in the region were two graduates of Dnipropetrovsk Metallurgical Institute, the Ukrainian-Moldovan Sergiy Tihipko, the First Secretary of the Dnipropetrovsk Komsomol regional organization in 1986–91, and the Ukrainian Oleksandr Turchynov, who worked with Tihipko as head of the agitation and propaganda division in the same Komsomol regional organisation in 1987–90. Tihipko and Turchynov initiated and ‘ideologically justified’ the first Komsomol businesses in the region. Two other Komsomol members, who also graduated from the same institute as Tihipko and Turchynov, Kolomoyskyy and Viktor Pinchuk, both of Jewish origin, started their careers not in the official Komsomol business, but on the black market of Dnipropetrovsk, trading various goods, and using their financial and engineering skills for their own survival in the conditions of economic collapse of late socialism. Kolomoyskyy used his financial skills and connections with Tihipko to organize its own financial corporation Privatbank, which became the most successful bank in post-Soviet Ukraine. Pinchuk, using his engineering and managerial skills, founded his own metallurgical venture, entitled Interpipe Company. It is noteworthy that all four of those Komsomol members, two Ukrainian and two Jewish, used their personal connections through their friends and partners from Pivdenmash, including through its last director Leonid Kuchma, to start their first businesses in Dnipropetrovsk (see Golovko 2012). In the mid-1980s, when perestroika created favourable conditions for the managerial skills of Komsomol activists, this system produced new activities for cultural consumption, such as video salons which brought their organisers more profits than traditional discotheque clubs. The video business used the same infrastructure and network of the discotheque movement; namely international tourism, Komsomol activists, trade union leaders and the ‘discotheque mafia.’ This network contributed to the business career of two fans of Western popular music, Yulia Tymoshenko and her husband, Oleksandr (Popov, Milshtein, 55; Ponamarchuk). Yulia Grigian (Telegina) was the daughter of Armenian taxi-driver Grigian and Russian technical worker Telegina, a fan of British rock music. Yulia Grigian married Oleksandr Tymoshenko, son of a member of the city KPU committee in the Pivdenmash administration. In 1978, Yulia Tymoshenko joined the student Komsomol organization in the Department of Economy at Dnipropetrovsk State University. This department was opened on the initiative of the Pivdenmash administration in 1977 to provide training for qualified economists in Dnipropetrovsk’s growing military industrial complex. Yulia Tymoshenko graduated with honours from the Department of Economy in 1984 and began her first job as an engineer-economist through the connections of her father-in-law, Hennadii Tymoshenko. For five years, she worked at the Lenin machine building plant, another factory which belonged to the Soviet military industrial complex. In 1979, she gave birth to her daughter Yevhenia, and until 1988 she and her husband enjoyed a typical Soviet upper-middle class life in their one-bedroom cooperative apartment. They continued to watch movies, listen to Western pop music, and occasionally visited and danced in well-known discotheque clubs in downtown Dnipropetrovsk (Popov and Milshtein 2006, 64–67; Suvorov 1991). Perestroika changed the young Tymoshenko family. Hennadii Tymoshenko recommended his son and daughter-in-law to join the co-operative movement and promised his support through the city’s KPU and Soviet administration. In 1988, the young Tymoshenkos used their old connections in the Komsomol discothèque world to open a public service enterprise, a video-rental shop in Dnipropetrovsk, with 5,000 borrowed Soviet roubles. The profits made from this first venture were used to open a chain of video rental stores. They used the experience of Komsomol apparatchiks, who brought their first VCRs in Dnipropetrovsk through Sputnik. Contacts in the discotheque movement helped provide these apparatchiks with Western video tapes and an audience which was ready to consume new Western cultural products. Former discotheque enthusiasts tested these new business practices and proposed the idea of video salons, which had already become the most popular and fashionable form of entertainment Moscow and the three Baltic republics. As a result, during perestroika both the Komsomol and ‘discotheque mafia’ provided infrastructure for these salons in Dnipropetrovsk. When in 1987the KGB opened the city of Dnipropetrovsk to foreigners, Pivdenmash imported thousands of VCRs using barter agreements with South Korean businessmen. As a regional KPU apparatchik who oversaw the distribution of movies throughout the Dnipropetrovsk region (kinoprokat), Yulia Tymoshenko’s father-in-law had access not only to these Korean VCRs but also to local movie theatres which provided the first mass audience for video films. The main base of a Tymoshenko’s ‘video enterprise’ was the location of the former central Komsomol discotheque club of Dnipropetrovsk oblast– the Student Palace in the Taras Shevchenko Park of Culture and Relaxation in downtown Dnipropetrovsk (Popov and Milshtein 2006, 52–89; Ponamarchuk 2007). In 1989, she quit her old engineer-economist job and became the head of the Terminal co-operative. The same year, another participant in the ‘discotheque mafia,’ Serhiy Tihipko, was elected as the first secretary of the Komsomol organization of Dnipropetrovsk oblast. He not only supported Tymoshenko’s enterprise, but also brought his additional discotheque and Sputnik connections into Terminal. In this way, discotheque activists and Komsomol apparatchiks contributed to the growth and popularity of Tymoshenko’s business (Tihipko). In 1991 after the disintegration of the Soviet Union and Soviet state tourism, the representatives of the Brezhnev era Komsomol elite, such as Tymoshenko demonstrated again that a skilful adjustment of this network to the new economic situation was an important foundation for success in post-Soviet business activities. The initial capital of Terminal, the music and video Komsomol enterprise which Tymoshenko had launched during ‘the discotheque era’ of late socialism, became the foundation of her business and political career in post-Soviet Ukraine. Epilogue: Dnipropetrovsk Komsomol Entrepreneurs and the Formation of Post-Soviet Oligarchs Political corruption in the post-Soviet geopolitical space is rooted in cultural consumption during the Brezhnev era, especially in the so-called ‘discotheque effect’ on society during the era of ‘mature socialism.’ During this period of late socialism in the USSR, millions of Soviet young people, loyal members of Komsomol, fell in love with the catchy sound of ‘beat music’ by the Beatles and hard rock by Deep Purple. Even ten years after dissolution of the Soviet Union, the post-Soviet space was ruled by former Soviet hard rock fans, representatives of the so-called ‘Deep Purple generation,’ new post-Soviet politicians, such as Russian Prime-Minister Dmitri Medvedev, twice Ukrainian Prime Minister Yulia Tymoshenko, President Petro Poroshenko and former Georgian President Mikheil Saakashvili. Paradoxically, détente in the 1970s led to the influx of Western cultural products into the USSR, such as popular music and feature films. As a result, Soviet ideologists, including the Komsomol, attempted to control Soviet consumption of cultural products from the West using ‘Komsomol discothèques’ where Soviet young people could dance to ‘ideologically permitted’ Soviet and Western music. Contemporaries called these organizers ‘disco mafia’ in the industrial cities of Eastern Ukraine. By the end of perestroika in 1991, more than 100 Komsomol businesses had emerged in industrial cities in Eastern Soviet Ukraine, of which more than ninety originated in the city of Dnipropetrovsk (Zhuk 2010, 301). Only a few of the most successful enterprises survived post-Soviet competition during the 1990s and created ‘new business corporations’ such as Yulia Tymoshenko’s ‘Gas Empire,’ Kolomoyskyy’s and Tihipko’s Privatbank, Aleksandr Balashov’s ‘Trade Corporation’ and Rinat Akhmetov’s Liuks. The overwhelming majority of these post-Soviet successful businesses were organised by or directly connected to the ‘disco mafia.’ At the same time, the first Dnipropetrovsk ‘capitalists’ demonstrated a wide range of ethnic backgrounds, from the Ukrainian Tihipko, Armenian-Russian Tymoshenko, Russian Balashov and Jewish Kolomoyskyy contributing to the multi-national identity of the city of Dnipropetrovsk and Dnipro. Some contemporaries noted how the business activities of Komsomol ‘entrepreneurs’ in the 1980s contributed to regional identity in Eastern Ukraine. Many of these ‘entrepreneurs’ who were not ethnic Ukrainians became active participants in the Ukrainian independence movement in 1988–1991 to protect their regional business interests rather than defending Ukrainian culture and language. In the 1990s, former members of the Soviet ‘discotheque mafia’ and their former KPU supervisors became an integral part of the business and political life of independent Ukraine. As leaders of oligarchic clans in Ukraine they have resisted Russian expansion into their ‘spheres of influence.’ The case of Volodymyr Zelenskyy, elected in April 2019, whose entire career was generated inside the Soviet-based system of television entertainment, continues to demonstrate the connection between ‘post-Komsomol‘ business and political careers. Zelenskyy began his acting career in 95-yi Kvartal, which was a reference to a neighbourhood in Kryvyy Rih, where he had grown up and was inspired by the 1960s Soviet television show KVN. As we see, the Dnipropetrovsk and Dnipro elites, who are still rooted in their Soviet past, play a significant role in the development of independent Ukraine. References Berkhoff, Karel C., (2004). Harvest of Despair: Life and Death in Ukraine under Nazi Rule. Cambridge, MA: Harvard University Press. Bolebrukh, Anatolii G. et al., eds., (2001). Dnipropetrovsk: vikhy istorii. Dnipropetrovsk: Grani. Derzhavnyy arkhiv Dnipropetrovskoyi oblasti (hereafter – DADO), f. 19, op. 52, spr. 72. Dnepropetrovskii raketno-kosmicheskii tsentr: Kratkii ocherk stanovlenia i razvitia. (1994). DAZ-YuMZ-KBYu: Khronika dat i sobytii. Dnipropetrovsk: YUMZ. Glushkina, Liudmila G. ed. (1985). Tsentral’noe Statisticheskoe Upravlenie Dnepropetrovskoi oblasti. Dnepropetrovshchina v tsifrakh. (K 40-letiu pobedy v Velikoi Otechestvennoi voine). Dnipropetrovsk: Gosstat. Golovko, Volodymyr. (2012). Ukrainski finasovo-promyslovi grupy v modernizatsiinykh protsesakh 1991-2009. Kyiv: Instytut istorii Ukrainy NAN Ukrainy. Goskomstat USSR. Dnepropetrovskoe oblatnoe upravlenie statistiki. (1991). Naselenie Dnepropetrovskoi oblasti po dannym Vsesoiuznoi perepisi naseleniia 1989 goda. Dnepropetrovsk: Gosstat. Hall, Rex, Shayler, David J. (2001). The Rocket Men: Vostok and Voskhod, the First Soviet Manned Spaceflights. Chichester, NJ: Springer. Horbulin, Volodymyr P. et al. eds. (1998). Zemni shlyakhy i zoryani orbity. Shtrykhy do portreta Leonida Kuchmy. Kyiv: DrUk. Kuznetskii, Mikhail I., Stazheva, Irina V. eds. (1995). Baikonur – chudo XX veka: Vospominania vevteranov Baikonura ob akademike Mikhaile Kuzmiche Yangele. Moscow: Kosmos. Kuznetskii, Mikhail I. ed. (1997). Baikonur, Korolev, Yangel. Voronezh: Kosmos. Lazebnik, Valentina I. (2001). G. A. Efimenko ed., Oziorka nasha: Istoricheskii ocherk o Dnepropetrovskom Tsentralnom rynke. Dnipropetrovsk: Grani. Lukanov, Yuriy. (1996). Tretii president: Politychnyi portret Leonida Kuchmy. Kyiv: Taki Spravy. Markov, Karlo A. (1995). Uchastie nemetskikh voennoplennykh i internirovannykh v vosstanovlenii narodnogo khoziaistva Dnepropetrovskoi oblastiv pervye polevoennye gody. Voprosy Germanskoi istorii: Ukrainsko-nemetskie sviazi v novoe i noveishee vremia. Mezhvuzovskii sbornik nauchnykh trudov, In: Svetlana Bobyliova, ed., Dnipropetrovsk: DDU, 158–172. Mlechin, Leonid M. (2005). Brezhnev. Moscow: Molodaia gvardia. Nahaylo, Bohdan. (1999). The Ukrainian Resurgence. Toronto: Hurst. O vozrastnoi structure, urovne obrazovania, natsional’nom sostave, iazykakh i istochnikakh sredstv sushchestvovania naselenia Dnepropetrovskoi oblasti po dannym Vsessoiuznoi perepisis naselenia na 15 ianvaria 1970 goda. (1971). Dneprovskaia Pravda, June 26. Pikhovshek, Vyacheslav, et al., eds. (1996). ‘Dnipropetrovska simya’: Informatsia stanom na 25 lystopada 1996 roku. Kyiv: Ukrainian Centre for Independent Political Research. Pikhovshek, Vyacheslav et al. Eds. (1996). Dnipropetrovsk vs. Security Service. Kyiv: Lybed. Platonov, Vitalii P. and Horbulin, Volodymyr.P. (1979). Mykhaylo K. Yangel. Kyiv: Nauka. Plyushch, Leonid. (1979). History’s Carnival: A Dissident’s Autobiography. New York: Harcourt Brace Jovanovich. Ponamarchuk, Dmytro. (2007). Prosto Yulia. Izvestia, September 20. Popov, Dmitrii, and Milshtein, Ilia. (2006). Oranzhevaia printsessa. Zagadka Yulii Timoshenko. Moscow: Izdatel’stvo Ol’gi Morozovoi. Romanov, Aleksandr P., Gubarev, Vladimir S. (1989). Konstruktory. Moscow: Molodaia gvardia. Siddiqi, Asif A. (2003). Sputnik and the Soviet Space Challenge. Gainesville: University Press of Florida. Elberg-Wilson, Eliot. (2016). ‘Eduard Artem’iev and the Sonics of National Identity,’ Slovo, 28, 2: 2–25. Strazheva, Irina V. (1978). Tiulpany s kosmodroma. Moscow: Molodaia gvardia. Vasiliev, I. V. et al. eds. (1977). Istoria gorodov i siol Ukrainskoi SSR v 26-ti tomakh: Dnepropetrovskaia oblast. Kyiv: Glavnaia redaktsia Ukrainskoi Sovestskoi Entsiklopedii. Vosstanovlenie Pridneprovia (1946–1950). (1980). Dokumenty i materially. Kyiv: Nauka. Wilson, Andrew. (2000). The Ukrainians: Unexpected Nation. New Haven, CT: Yale University Press Zhuk, Sergei. (2004). Russia’s Lost Reformation: Peasants, Millennialism and Radical Sects in Southern Russia and Ukraine, 1830–1917. Baltimore, MD & Washington D.C: Johns Hopkins University Press and Woodrow Wilson Centre Press. Zhuk, Sergei (2010). Rock and Roll in the Rocket City: The West, Identity, and Ideology in Soviet Dniepropetrovsk, 1960–1985. Baltimore, MD & Washington D.C: Johns Hopkins University Press and Woodrow Wilson Centre Press. **Interviews**Igor T., KGB officer, 15 May 1991, Dnipropetrovsk. Karlo A. Markov, 12 April 1992, Dnipropetrovsk State University. Mikhail Suvorov, 1 June 1991, Dnipropetrovsk. Natalia V. Bocharova, 15 March 1993, Dnipropetrovsk State University. Sergiy Tihipko, director of Privatbank in Dnipropetrovsk, 12 October 1993, Dnipropetrovsk. Yevhen D. Prudchenko and Halyna V. Smolenska, 18 July 2007, Central Library of Dnipropetrovsk oblast, Dnipropetrovsk. Notes [1] I used also numerous interviews conducted with my relatives, who are ethnic Ukrainians, but live in Moscow, Russia, who still support Russian President Vladimir Putin’s anti-Ukrainian politics. [2] Sovnarkhoz is abbreviated from Russian Sovet narodnogo khoziaistva, an economic department in the Soviet government during the early Stalin era and during Khrushchev’s reforms.
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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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