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Earth Science Tech (ETST) Wins Through the Inherent Operating Leverage of Its ‘Conglomerate’ Business Model
Austin, Texas, November 4th, 2026, FinanceWireEarth Science Tech (OTCQB: ETST) is a strategic holding company that brings together innovative businesses across the healthcare, pharmacy, technology and telemedicine, real estate, and consumer products spaces. Its primary operating strategy is to cont…
Wyoming poised to welcome new major political party based on Bextel’s vote totals
The Constitution Party is set to become the state’s third major party.
Pennsylvania Flips Senate, Secures Cannabis Legalization Trifecta
The state’s Democrats gained control of the upper chamber for the first time in more than three decades, paving the way to legalize adult-use cannabis.
How Trump and Republicans lost the 2026 midterm elections, according to AP Voter Poll
After more than a decade with Donald Trump at the epicenter of U.S. politics, most voters appear exhausted and exasperated by him, according to The AP Voter Poll, a survey of midterm voters in all 50 states.
Michigan State at Michigan Football: Final Score Prediction
Two struggling offenses and powerhouse defenses collide under the Big House lights as the Spartans seek a desperate upset against Tommy Carr’s favored Wolverine squad.
What We Learned About College Football in Week 9
Ohio State Might be in Trouble It’s hard to imagine Ohio State being left out of the playoff picture, but it may just happen. The Buckeyes seemed to be about as much of a lock as you could find, as a program that has consistently played at or near a championship level and always seems […]
ARCare triples nurse capacity by combining RPM and chronic care management
A redesigned nursing workflow connects home blood pressure readings with patient relationships – expanding remote monitoring across three states.
Texas high school football playoffs: Dates, brackets, schedule
When do the 2026 Texas high school football playoffs begin? Here's when brackets are released, the first-round schedule and state championship dates.
The Future of Democracy
The 2026 midterm elections didn’t just determine who controls Congress for the next two years—they also determined whether the United States, 250 years after its founding, remains a democracy, Anne Applebaum says. She explores what citizens and lawmakers can do next to strengthen the institutions and values that have been threatened in the Trump era.
College Football Playoff rankings: Miami leads first rankings of 2026; Notre Dame, Ohio State outside top 10
Brandon Aiyuk reporting to 49ers
San Francisco 49ers WR Brandon Aiyuk has submitted paperwork to be reinstated, his agent Drew Rosenhaus said.
Madison Square Garden Entertainment Corp reports results for the quarter ended September 30
FORECAST CHANGESRECOMMENDATIONSThis summary was machine generated from LSEG data November 4 at 02:32 p.m. UTC. All figures in US dollars unless otherwise stated. (For questions concerning the data in this report, contact Estimates.Support@lseg.com. For any other questions or feedback, contact Refi…
Farm acres the top recent property deal in Craighead County
Bane Land Farm and Cattle and Tebo Land LLC made the most significant residential and commercial property transfer in Craighead County from Sept. 15 to Oct. 15, according to the...
What a blue wave means for North Carolina. Reporters, political watchers join Due South for post-election analysis
Due South’s Jeff Tiberii and a panel of reporters and political scientists dig into the election results and what they mean for our state and our country.
Breaking Down Penn State Offense Improvement
The Penn State offense has struggled since the beginning of Big Ten play at the end of September. The Nittany Lions didn't score more than 23 points in their last four games; that was until Saturday's 31-17 victory over Purdue. It was a refreshing showing from Taylor Mouser's group. The ground game looked competent, the …
The Universe Should Be Empty. A Single Trapped Antiparticle Might Finally Reveal Why It Isn’t.
Scientists chilled a single positron to its quantum ground state, chasing physics’ biggest mystery.
USC political science expert breaks down S.C. elections
South Carolina voters reshaped the state’s political landscape Tuesday night.
From science experiments to “exploration at scale”
Panellists from State Street, SIX, Standard Chartered, Calastone and BNP Paribas explain why the industry is moving to tokenisation, and take stock of regulation, technology and infrastructure. Regulators are now a springboard for growth, but client interest still isn’t turning into live products. What’s missing is a use case that pays for itself quickly.
‘A win the size of Texas’: Democrats celebrate shrinking Republican dominance in a big state
Voters watched results in near disbelief as James Talarico claimed victory in Senate race and Gina Hinojosa was elected state’s first Latina governor
Democrats take full control of Legislature, Michigan government. What to expect
Gov.-elect Jocelyn Benson can expect smooth sailing for her agenda, as Democrats win the state House, grow their Senate majority and maintain control of the Supreme Court, attorney general and secretary of state.
Mavs at Spurs Preview: Wemby Vs. 'Dangerous' Dallas Combo
Rookie sensation Cooper Flagg joins Kyrie Irving to challenge Victor Wembanyama’s surging Spurs, as Dallas seeks revenge and a statement win in this high-stakes, nationally televised rivalry.
Buckeyes Roll into Saturday's Game as Massive Favorites Against Oregon
Ohio State opens as massive favorites on Saturday against the Oregon Ducks.
Democrats win governorships in Texas and other GOP-controlled states in rebuke to Republicans
The wins delivered a majority of governorships to Democrats for the first time in two decades, allowing them to put up a stronger defense against Trump's second-term agenda.
Askeland upsets Ladyman in House race
In a surprise state house race, Democrat Erika Askeland defeated her incumbent opponent Jack Ladyman R-Jonesboro on election night (Nov. 3). With more than 100% of the votes counted, she...
Askeland upsets Ladyman in House race
In a surprise state house race, Democrat Erika Askeland defeated her incumbent opponent Jack Ladyman R-Jonesboro on election night (Nov. 3). With more than 100% of the votes counted, she...
Ohio State earth science professor Lonnie Thompson dies after brief illness at 78
Ohio State University is mourning the loss of a longtime professor whose work helped elevate the university’s global reputation in climate research.OSU Presiden
‘A mandate for change’: Democrats remake Texas politics in election rout
By Brad Brooks Nov 4 (Reuters) - Texas Democrats, shut out of every statewide office for more than three decades, have toppled Republicans from the top of the ballot to the bottom, remaking the political landscape of the nation’s largest conservative s...
'A Mandate for Change': Democrats Remake Texas Politics in Election Rout
By Brad Brooks Nov 4 (Reuters) - Texas Democrats, shut out of every statewide office for more than three decades, have toppled Republicans from the top of the ballot to the bottom, remaking the political landscape of the nation’s largest conservative state in a single earth-shattering night.
How space weather shapes young planets
Scientists suspect powerful solar flares helped strip away the atmospheres of planets like Mars. A Michigan State University researcher is now searching for evidence of how those same forces shape planets beyond our solar system. Adina Feinstein, assistant professor of physics and astronomy, believes exoplanets are the key to understanding the early days of our solar system. This week, she received a Schmidt Sciences FirstLight grant to investigate how space weather influences young planets.
Major Changes to Hemp Regulation Are Taking Effect: Is Your Business Ready?
The hemp industry is preparing for significant federal restrictions that will change which hemp-derived products can legally remain on the market, with key provisions taking effect in November and December. At the same time, states continue to take different approaches to intoxicating hemp products, creating added complexity for manufacturers, retailers and consumer brands.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
The political map is anyone's guess after a Democratic wave in the midterm elections
Voters have dramatically shifted the political landscape by electing Democrats in traditionally Republican states.
State employees to see small jump in health premiums under new PEIA proposal
During a hearing Thursday, Oct. 29, 2026, the PEIA Finance Board released a plan that raised health insurance premiums 2% next year. This affects West Virginia state government employees.
Tenerife to hold memorial service for De Miguel on Saturday
Spain's CD Tenerife will hold a memorial service to bid farewell to their late forward Jesús de Miguel on Saturday, the second division club said in a statement. All fans are invited to attend a mass, which will be held at the Heliodoro Rodríguez López stadium.
Commentary: West Virginia’s doctors and federal workers fear the paper trail
Along Interstate 79 in North Central West Virginia, two kinds of workers carry a quiet fear about their own mental health.
Historic election reshapes Georgia's political future: Here's what happened
Georgia voters made history Tuesday, electing Keisha Lance Bottoms as the state's first female governor, returning Sen. Jon Ossoff to Washington and flipping several statewide offices to Democrats.
How a scientist went from hero to traitor in a US water crisis
When the water in Flint, Michigan, became contaminated with dangerous levels of lead, Dr Siddhartha Roy, then a third year PhD student, was part of the team of scientists who publicly contradicted state and federal claims that it was safe. He became a local hero until a new piece of research challenged the idea that children in Flint had been left permanently brain damaged by the crisis. His adherence to the evidence, no matter who it offended, has earned him the 2026 Maddox prize, which recognises individuals who stand up for science and evidence, despite challenges or hostility. He tells Ian Sample how he reflects on his experience in Flint, and why he lost friends as a result of his work there
Letters: Science isn’t scary, it’s educational | Book-ban hypocrisy
Science is wonder; evolution isn’t scary Regarding the claim that the state education plan is de-emphasizing evolution (“Florida education chief defends science plan as critics say it ‘danced around’ evolution,” Oct. 28): Science is won…
Berks Nature to Launch New Mental Health Effort
During the 18th annual State of the Environment Breakfast, Berks Nature will introduce the first tool in what the nonprofit envisions as a multidisciplinary community partnership to help local youth find peace, healing, and connection in nature: a map of Reading’s 50+ parks, playgrounds, and green spaces.
49ers Get Strong Message After Brandon Aiyuk Hires Drew Rosenhaus
After being away from the news cycle for a few months, San Francisco 49ers wideout Brandon Aiyuk is back after he hired Drew Rosenhaus to represent him. As a result, Aiyuk looks ready to return to playing football, but will that be with the Niners?Aiyuk will need to apply for reinstatement, given that he’s on […] The post 49ers Get Strong Message After Brandon Aiyuk Hires Drew Rosenhaus appeared first on HEAVY.
See Brevard County's high school football live scoreboard, Week 12
Five games comprise the Nov. 4-6 slate as three FHSAA teams make up games with three SSAA teams looking to advance in state playoffs.
IVF Patients, Doctors Navigate Fetal Personhood Laws’ Unknowns
People trying to start families and clinics trying to help them have been left confused and worried since the Supreme Court overturned Roe v. Wade, triggering fetal personhood laws in several states.
Brenda Lucas: Community news for Wednesday, Nov. 4
Click for community news in the Huntington, West Virginia, and Tri-State area.
Super 25 Massachusetts high school football rankings entering playoffs
Jason Snow, Chris McDaniel and Tim Whelan rank the top MIAA football teams every week of the season. This is the Super 25 entering the state playoffs.
Texas Democrats pull off the breakthrough they’ve chased for decades
For decades, Texas Democrats have dreamt of turning the state blue, rallying around exciting candidates who drew big crowds and big money but could not ultimately overcome the state’s stubborn conservative majority.
Star Health's Arogya Seva Kendra clinics cross 1.8+ lakh beneficiary visits within a year of their inception, bringing free primary healthcare to communities across 9 states
Star Health and Allied Insurance Company Limited (NSE: STARHEALTH) (BSE: 543412), India's leading standalone health insurer, has been safeguarding the health and well-being of millions of Indians for over 20 years through a strong focus on customer-centricity, transparency, and innovation. Reflecting its commitment to creating lasting social impact, Star Health's CSR initiatives focus on improving health outcomes through accessible healthcare, preventive interventions, and community wellness pro
Washington voters backing initiative to keep transgender girls out of girls’ sports
Washington state voters backing initiative to ban transgender girls from girls' sports, election results show
It’s time to reunite
Election season is over. Most of us exercised our constitutional right to choose representatives for office who best reflected our values and those we believed were best prepared to lead and solve the very real challenges facing our state, nation and county. The 2026 election season was full of both extreme highs and extreme lows. […]
Democrats seize power in Texas, ending decades of GOP dominance
Texas’ governor, lieutenant governor, attorney general and every other statewide candidate fell, upending the state’s political power structure in one night.
Abdul El-Sayed Wins Michigan Senate Race, Making History as First Muslim Senator
El-Sayed has defeated former Rep. Mike Rogers in Michigan’s open Senate race, making him the first Muslim elected to the United States Senate.
Russell Wilson takes first step towards NC State coaching job after CBS move
Russell Wilson has interviewed for the vacant NC State head coaching job, just months after retiring from the NFL and joining CBS Sports as an analyst. The former Seattle Seahawks quarterback is now one of two high-profile candidates linked with the role, alongside Philip Rivers, who also played college football for the Wolfpack.
Angry Voters Usher in Beginning of the End to the Trump Era
The electoral backlash extended even into deep red states and indicated that President Trump has lost his hold over the coalition that lifted him to the White House twice.
Ex-UK political aide Steve Hilton loses bid for California governor
Hilton, who was endorsed by President Trump, faced an uphill battle as a Republican in the widely liberal state.
Nebraska voters appear to say 'no' to legalizing online sports betting
Though margins were still slim late Tuesday night, Nebraska voters were on track to reject a pair of ballot measures looking to legalize and regulate online sports betting, according to unofficial results. Initiative Measures 440 and 441 would together amend the Nebraska Constitution and state law, respectively, to legalize and regulate online sports wagers. Initiative […]
WATCH: Democrat Annie Andrews' full victory speech after flipping South Carolina Senate seat
Andrews' victory in a state President Donald Trump won three times by double digits is a stark defeat for the Republican Party.
Washington initiative to ban trans students from girls’ sports ahead in early returns
A statewide ban on transgender students competing in girls’ school sports was leading on election night, according to early tallies.
Political analysts discuss Wisconsin governor's race results
Democrat David Crowley defeated a Republican with close ties to President Donald Trump on Tuesday, rising from a childhood in one of the nation’s poorest neighborhoods to become the first Black person to lead the battleground state.
Nebraska on track to add gender-based school sports requirements to state Constitution
Voters appeared to agree to cement sex-separate school sports requirements into the Nebraska Constitution with the approval of the Fairness for Girls ballot measure.
Democrats flip four governorships, extending the party’s inroads into red states
Republicans entered Tuesday’s midterms with a 26-24 advantage in governor’s offices across the country.
Here are the results from the sports wagering ballot measures
Two ballot measures are seeking a constitutional amendment to legalize online sports betting in the state and to create the regulatory framework to tax the wagers.
WATCH: Democrat James Talarico speaks after winning Texas Senate seat
Talarico's victory represents the first time a Democrat has won a statewide office in Texas since 1994, a shakeup for a state long dominated by Republicans.
Amy Acton reflects on her childhood in acceptance speech
Democrat Amy Acton reflected on her journey from childhood homelessness to becoming a doctor and now projected as Ohio’s next governor as she celebrated her win over Republican Vivek Ramaswamy. The former state health director will become the first woman elected governor of Ohio and the first Democrat to win the office since 2006.
SC secretary of state wins 7th term leading office for business filings
South Carolina’s longtime secretary of state, Mark Hammond, won a seventh term in office.
Cannabis Legalization Prevails in Massachusetts; Repeal Question Soundly Defeated
Ten years after legalizing adult-use cannabis, the Bay State voters rejected a prohibitionist proposal, Question 8, which aimed to wipe out the industry.
‘Became a RINO’: President Donald Trump blames Abbott’s lost in Texas governor race on political life
Republican President Donald Trump released a public statement after incumbent Republican Greg Abbott conceded the Texas governor’s race to Democrat Gina Hinojosa.
Texas Politics Enter a New Era After Hinojosa's Win
Texas State Rep. Gina Hinojosa won the race for governor, the first Democrat to win the office since 1990. She beat incumbent Greg Abbott, who was seeking a fourth term.
Nature comes to life in ‘MOMIX: Botanica’ at the Schaefer Center on Nov. 12
MOMIX presents Botanica, a visually stunning dance and illusion show exploring nature’s rhythms, at Appalachian State University’s Schaefer Center on November 12. This multisensory performance combines athleticism, inventive props, and atmospheric music to transform dancers into flowers, insects, and fantastical creatures.
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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