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Acadia’s Bed Ramp Strategy Begins to Pay Off
Acadia Healthcare (Nasdaq: ACHC) had a strong third quarter with $895.3 million in total revenue, up 5.1% compared with the same period in
Acadia’s Bed Ramp Strategy Begins to Pay Off
Acadia Healthcare (Nasdaq: ACHC) had a strong third quarter with $895.3 million in total revenue, up 5.1% compared with the same period in
10 things to know about saunas, from stress relief to dehydration risks
A Cleveland Clinic family medicine doctor explains what sauna heat may do for stress, the heart, and pain, and when to skip a session.
Hurricanes Saw Incredible 14-Game Feat End Before Isles Matchup
The Carolina Hurricanes were putting on quite an encore presentation early in 2026-27. That encore hit a speed bump on Tuesday.Walt Ruff and Peter Dewar of Hurricanes.com shared that, in Tuesday night’s loss to the Nashville Predators, “Carolina trailed by a pair of goals for the first time since Oct. 2 and could never recover, […] The post Hurricanes Saw Incredible 14-Game Feat End Before Isles Matchup appeared first on HEAVY.
Scientists discover an organism that can survive conditions once thought impossible
NASA-funded research identified an organism, a fire amoeba, that divides at 145°F, expanding beyond the known heat limits of complex life.
SETI and Fermi Paradox Are Nextdoor Neighbors of ID
What do SETI researchers, usually atheists or agnostics (cf. Jill Tarter as an example of the former, Carl Sagan of the latter), want to find? Evidence of MIND.
CERES Ocean Validation Experiment (COVE)
After 17 years of continuous operation, the CERES Ocean Validation Experiment (COVE) at Chesapeake Light Station, has been indefinitely suspended due to
Medicus Pharma proposes $135M SkinJect spinout through SPAC business combination
Medicus Pharma CEO Dr Raza Bokhari joined Steve Darling from Proactive to discuss a proposed transaction involving the company's wholly owned subsidiary, SkinJect, which has entered into a non-binding letter of intent with an undisclosed special purpose acquisition company (SPAC) for a potential business combination. The proposed transaction contemplates a US$135 million pre-money enterprise valuation for SkinJect, alongside a concurrent equity financing intended to support the company's SKNJCT-005 clinical study in patients with Gorlin syndrome and preparations for a potential New Drug Application (NDA). Bokhari told Proactive that the proposed deal is designed to establish SkinJect as a separately listed company focused on advancing its dermatology and rare-disease development program. Under the proposed structure, the SPAC would acquire 100% of SkinJect in exchange for newly issued common shares in the combined company. Medicus Pharma intends to retain majority economic and voting ownership, allowing existing Medicus shareholders to maintain significant participation in SkinJect's potential future value. The separation would also provide SkinJect with a dedicated financing platform to fund its clinical development activities, particularly the SKNJCT-005 study targeting Gorlin syndrome, a rare genetic condition associated with the development of multiple basal cell carcinomas. The concurrent financing is expected to support the clinical program and the work required to prepare and potentially submit a New Drug Application, subject to successful development and regulatory progress. Final ownership percentages have not yet been determined. These will depend on negotiations surrounding the definitive transaction agreement and the combined company's capitalization, including retained SPAC cash, public and sponsor shares, warrants and other potentially dilutive securities. Medicus said the proposed transaction remains subject to the completion of definitive documentation and other customary conditions. The planned spinout represents a strategic step in Medicus Pharma's efforts to give SkinJect a dedicated corporate and financial structure, while allowing the parent company to retain majority participation as the dermatology program advances towards its next clinical and regulatory milestones. #proactiveinvestors #nasdaq #mdcx #tsxv #mdcx #pharma #SkinJect #Biotechnology #Healthcare #RareDisease #GorlinSyndrome #Dermatology #SPAC #ClinicalTrials #DrugDevelopment #NDA #Biopharmaceuticals
US Department of Justice Intervenes in Health Insurance Whistleblower Lawsuit Brought by Lieff Cabraser Against Centene Corporation
The Lieff Cabraser law firm represents a former employee. NASHVILLE, Tenn.–(BUSINESS WIRE)–On October 27, 2026, the United States sued one of the nation’s largest health insurance companies, Centene Corporation, for fraud under the False Claims Act. Lieff Cabraser’s Nashville Office is proud to represent the relator, who brought this matter to the government after internal
Will NASA's newest X-plane bring science fiction to life?
NASA has unveiled its latest X-plane vision, promising a platform that will advance flight control tech far beyond anything tested in a crewed aircraft before.
MBody AI Doubles Deployment at Major Northeast Casino & Entertainment Destination
Nasdaq-listed physical AI company grows it’s support at Mohegan Sun’s Environmental Services (EVS) team after successful pilot program MBody AI Doubles Deployment at Mohegan Sun An extended three-year agreement follows a successful paid pilot and a larger multi-year commitment. Highlights Deployment Doubled: Mohegan Sun has doubled its MBody AI deployment, with expanded operations already underway.Three-Year Agreement: The commercial agreement covers both the previously announced original instal
Alton Brown will serve up food, science, humor at Fargo Theatre
Other weekend highlights include Bounce in the Valley, a Scandinavian chamber concert, art openings and a reading.
PENN Entertainment (NASDAQ:PENN) reports Q3 2026 in line with expectations
Casino, sports betting and entertainment operator PENN Entertainment NASDAQ:PENNmet Wall Street’s revenue expectations in Q3 2026, with revenue up 7.1% year on year to $1.84 billion. Its non-GAAP profit of $0.32 per share was significantly above analysts’ consensus estimates.For more on PENN Entert…
PENN Entertainment (NASDAQ:PENN) reports Q3 2026 in line with expectations
Casino, sports betting and entertainment operator PENN Entertainment (NASDAQ:PENN) met Wall Street’s revenue expectations in Q3 2026, with revenue up 7.1% year on year to $1.84 billion. Its non-GAAP profit of $0.32 per share was significantly above analysts’ consensus estimates.
Tennessee judge extends block on immigration checks in HIV/AIDS program
A Nashville judge continued to block the Tennessee Department of Health from demanding proof of citizenship from HIV-positive individuals.
Innate Pharma Reports Third Quarter 2026 Business and Financial Update
MARSEILLE, France, November 05, 2026--Regulatory News: Innate Pharma SA (Euronext Paris: IPH; Nasdaq: IPHA) ("Innate" or the "Company") today reported its financial update for the nine months ended September 30, 2026.
Cyprus: Island of Snakes, Cats, and Ophiolites
The third-largest island in the Mediterranean Sea exposes an ancient piece of the ocean floor and hosts a clowder of cats.
Weekly entertainment report: Live music and lively arts, Nov. 5-8 » Nashua Ink Link
Make it a musical weekend.
Hurricanes Get Honest Assessment on What They Lacked vs. Predators
The Carolina Hurricanes had gone four games without a loss, having defeated the Winnipeg Jets 7-0, the Columbus Blue Jackets 3-2, the Boston Bruins 2-1, and the St. Louis Blues 4-0 in their previous four outings. However, their streak ended on Tuesday, November 3, when they suffered a 4-1 defeat to the Nashville Predators. Following […] The post Hurricanes Get Honest Assessment on What They Lacked vs. Predators appeared first on HEAVY.
Barrett Business Services Q3 Earnings Call Highlights
Barrett Business Services (NASDAQ:BBSI) reported higher third-quarter gross billings but lower earnings per share as new client additions were offset by workforce reductions among existing customers and smaller favorable workers’ compensation adjustments. The company lowered its full-year outlook f
Shine Bright for Voyager’s Light‑Day
Use our Automated “V-G-R” Flasher to send your signal to Voyager, or if you want to try Morse code yourself, see our “Shine Bright” Step-by-Step instructions
Scientists reveal how cosignaling receptors dually regulate T cell activation via phase separation
Previous studies have shown that upon antigen stimulation, the T cell receptor (TCR) undergoes phase separation with the kinase Lck to mediate rapid T cell activation. However, the manner in which costimulating ...
A NASA space telescope plunged back to Earth after a mission that lasted 11 times longer than planned
The Swift Observatory's demise came less than three months after a long-shot rescue mission failed.
Illumina selected to help bring precision medicine into everyday healthcare in Singapore
Illumina, Inc. (Nasdaq: ILMN) announced it has been selected to provide whole-genome sequencing services for the SG-INSIGHT study, a cohort under Phase III of Singapore's National Precision Medicine (NPM) programme. Expected to include approximately one in 10 Singapore residents, or around 450,000 individuals, the study is designed to generate evidence from genomic and health data to help inform preventive approaches to healthcare.
Swift has fallen: NASA's 22-year-old space telescope burns up over Sumatra
The reentry of NASA's dead Swift space telescope is the end of an era for rapid-response space science.
Bickley: Gardner Minshew is rewriting the Arizona Cardinals playbook
Stay ready, my friends: Gardner Minshew is bringing Minshew Mania to the desert, Dan Bickley writes.
Appeals court strikes down Nassau County transgender sports ban
The lawsuit was brought by the New York Civil Liberties Union in 2024 on behalf of the Long Island Roller Rebels, a women's roller derby team that welcomes all athletes.
Artemis II geologist talks historic lunar science mission
Megan Borel, a geologist for the National Aeronautics and Space Administration (NASA)’s Artemis II lunar science team, delivered a talk titled “The Moon Joy of Artemis” hosted by the departments of geology and physics Oct. 29 in Fowler Hall. Geology professor Nikki Seymour said she knew Borel previously and organized the talk. Seymour said her […]
Addus Sees ‘Green Spaces’ in Hospice, Home Health M&A
Addus HomeCare Corp. (Nasdaq: ADUS) is anticipating a robust deal-making year on the horizon as the company zeroes in on the home health and hospice
Carson Hocevar Will Address the Media at Homestead-Miami Speedway
Suspended NASCAR Cup Series driver Carson Hocevar will address the media Friday at Homestead-Miami Speedway.
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.
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.
Arizona Sports' John Gambadoro taking Suns pregame free throw: 'I don't get nervous in stuff like this'
The confident co-host of the Burns & Gambo show is not worried about whether or not he will make the shot.
New nurses find family and fulfillment in long-term care
The group found support in each other during nursing school and at Good Samaritan - Comforcare, where all four RNs work today.
PAVS Subsidiary 2Lab3 Launches AniMano+, an AI-Native Digital Entertainment Streaming Platform, on the Apple App Store
NEW YORK, NY / ACCESS Newswire / November 4, 2026 / Paranovus Entertainment Technology Ltd. NASDAQ:PAVS ("PAVS" or the "Company") today announced that its subsidiary, 2Lab3, launched AniMano+, an AI-native, vertical-first short-form dramas and animation streaming app, on the Apple App Store on Octo…
PAVS Subsidiary 2Lab3 Launches AniMano+, an AI-Native Digital Entertainment Streaming Platform, on the Apple App Store
NEW YORK, NY / ACCESS Newswire / November 4, 2026 / (NASDAQ:PAVS) ("PAVS" or the "Company") today announced that its subsidiary, 2Lab3, launched AniMano+, an AI-native, vertical-first short-form dramas and animation streaming app, on the Apple App Store on October 23, 2026.AniMano+ combines storytelling and creative expertise with AI-enabled content production capabilities to develop entertainment for global audiences.
Video: McKennie joins Juventus group training before AZ Alkmaar clash
Juventus midfielder Weston McKennie trained with his teammates at Continassa this morning, on the eve of a Europa League game against AZ Alkmaar.Juventus are preparing for Thursday’s away Europa Lea...
Flutter Entertainment (NYSE:FLUT) reports sales below analyst estimates in Q3 2026 earnings
Global online betting company Flutter Entertainment (NASDAQ:FLUT) fell short of the market’s revenue expectations in Q3 2026 as revenue rose 2.1% year on year to $3.87 billion. Its non-GAAP loss of $0.18 per share was significantly below analysts’ consensus estimates.For more on Flutter Entertainme…
Scientists call on Ecuador to stop the rising trafficking of Galápagos iguanas
Ecuadorian authorities said they caught a Russian woman at the airport in Quito, the capital city, trying to smuggle 32 live marine iguanas, endemic to the Galápagos Islands. The iguanas — bound and stuffed in eight plastic boxes — were headed to Iceland. The dehydrated lizards were transferred to a conservation center in Pichincha for […]
Xeris adds longtime biotech exec to its board
The move to bring Menassie Taddese on comes amid reports that the Chicago-based rare disease and endocrinology drug company is being considered for acquisition.
$2 Million Settlement Resolves Covenant Health Data Breach Lawsuit
Covenant Health, St. Joseph Healthcare Foundation, St. Joseph Hospital, St. Joseph Hospital Nashua, N.H., and other Covenant Health facilities were named Covenant Health, St. Joseph Healthcare Foundation, St. Joseph Hospital, St. Joseph Hospital Nashua, N.H., and other Covenant Health facilities have agreed to pay $2 million to settle a class action lawsuit stemming from a May 2025 security incident.
Watch Live Sports Online & Stream FOX Sports
Watch live sports online with FOX One. Stream NFL, college football, MLB, NASCAR, INDYCAR and more, plus FOX Sports shows. Start your 3-day free trial.
Lightning’s Nikita Kucherov has been on fire since trade request
Nikita Kucherov wants out of the Tampa Bay Lightning , but he still can’t stop going all out for his team. Reports surfaced last Friday that the 33-year-old Kucherov had already asked the Lightning to move him. In the two games since, the two-time Hart Memorial Trophy winner has done nothing on the ice but rack up points. Against the Nashville […] The post Lightning’s Nikita Kucherov has been on fire since trade request appeared first on ClutchPoints.
Before the Dawn in America’s Heartland
With hardly a cloud in sight, astronauts had a sweeping view of nighttime lights in the U.S. Midwest.
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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