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How AI Is Changing the Way Business Leaders Make Decisions
BoF sits down with Bianca Anghelina, founder and CEO of decision intelligence platform Aily Labs, to explore her vision for AI-powered leadership, why better decisions are the key to business growth and what it takes to turn AI ambition into measurable impact.
Meta President on Data Center Politics
Dina Powell McCormick of Meta tells WSJ editor-in-chief Emma Tucker that a newly elected Governor who ran on a data center platform said "as soon as we get past the inauguration, let's meet, because we don't want to lose this investment."
‘This is a pretty remarkable time,’ Maryland Gov. Wes Moore says on historic governor elections
Star mathematician Ma Xiao leaves the US for China – and a career pivot to AI
The 28-year-old helped achieve a breakthrough on Hilbert’s sixth problem and now he’s embracing the ‘new era’ of artificial intelligence.
Local writers earn National Entertainment Journalism Awards finalist spots
Telling local stories that matter and are award-worthy.
Simonelli Group unveils Science Driven Coffee Cup programme
The Simonelli Group and the University of Camerino have unveiled the programme for the inaugural Science Driven Coffee Cup, bringing together leading researchers and coffee professionals to explore advances in coffee chemistry, neuroscience, artificial intelligence, sustainability, and quality control at the conference in Italy on 19-20 November.
Africa and Europe seek their own path in AI science
Africa and Europe are seeking to chart their own course in the rapidly accelerating global artificial intelligence race, with a partnership built arou...
Why presidential hopefuls are gathering in Denver next week
CNN’s Kasie Hunt explains why a meeting of prominent Democrats in Denver could provide a glimpse into who will be the party’s presidential contenders for 2028.
‘Hegseth has been a disaster’: Sen. Kelly tells CNN
Sen. Mark Kelly (D-AZ) called Trump’s handling of the Iran war a “complete disaster,” as he argued Democrats should use congressional power to push for an end to the conflict.
Florida Governor-elect says GOP must focus on lowering costs
While Republicans saw losses in the midterms, Florida Governor-elect Byron Donalds told CNN’s Dana Bash that if the party focuses on affordability and prices, the “elections will take care of themselves.”
‘Rent is due’: Mamdani on Americans rebuking Trump administration
New York Mayor Zohran Mamdani told CNN’s Jake Tapper that the midterm election results reflect working-class Americans’ frustration over the government’s failure to address their concerns.
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.
Jake Dickert’s Stand at Wake Forest
Jake Dickert’s name probably comes up more than he would prefer these days. He will tell you that he gets too much credit for his Wake Forest team being 7-1 and in contention for the ACC Championship game. His name also gets mentioned with every college football head coach job opening. And then there is …
Vance tosses Trump under the bus in a bid to keep 2028 hope alive
Vice President JD Vance on Wednesday surveyed the wreckage of the MAGA coalition and spilled his thoughts in an extraordinary social media post that launched the 2028 presidential campaign.
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.
Trans sports bans get voter approval in 4 states
Voters in four states — Arizona, Colorado, Nebraska and Washington — are on track to pass or have passed measures to restrict transgender athletes’ participation in sports, a key policy focus of the Trump administration.
Trump talks ballroom construction day after election shellacking
President Donald Trump highlighted the new White House ballroom construction Wednesday, a day after Democrats swept the midterm elections, while fielding questions about how he closed out the campaign.
Sonesta International Hotels Brings Exclusive Access to Billboard Latin Week
Sonesta Travel Pass members had their En Vivo experience taken to the next level
Brandywine student lands a spot at Jefferson Health’s Volunteer Medical Program
This past summer, third-year biology student Aaliyna Patel took an important step toward her future career in medicine through a volunteer internship with Jefferson Health’s Abington Hospital.
Republicans quickly turn against Pete Hegseth after midterms rout
President Donald Trump may have made the decision to launch the war that tanked voters’ support for the GOP and dealt them a midterm shellacking. But the historic losses are accelerating a push for someone else to take the fall: Defense Secretary Pete Hegseth.
Startup targets new pain point: nighttime | Investors Lab
It's our job to report on investment-worthy innovations coming to market. That doesn't mean we always believe they're in the best interests of the planet. Case in point: a new space-tech project that aims to solve the "problem" of nighttime. With their planned constellation of orbiting satellites equipped with giant mirrors that would beam sunlight to the night side of Earth on demand, the company behind the invention is attracting investors. SN's Lisa Grossman enlightens us.
Mapping the hidden hazards beneath our feet | Investors Lab
From unstable slopes to former industrial sites to hurricane alleys, some places are not safe to live in. Yet circumstances often force low-income populations into these areas, where natural disasters can have devastating effects. Rebecca Dzombak fills in the details for SN. And we have intel on advanced imagery and subsurface mapping that aim to provide early warnings before disasters strike.
Bavarian politician Hubert Aiwanger found dead in Berlin hotel
Aiwanger was Bavaria's economic minister and the chairman of the Free Voters Party. The circumstances surrounding his death are still unclear.
How Mississippi became an unlikely Senate battleground
An unpopular president, a charismatic Democratic candidate and an incumbent who has underperformed other Republicans in recent elections have turned a US Senate race in Mississippi into the nail-biter of the midterms.
Satellite images show what may be behind Microsoft AI buildout delays
Satellite images reveal potential delays at two Microsoft AI data center projects, highlighting power and permitting challenges facing neoclouds.
The biggest winners and losers of the 2026 midterm elections
Among the winners: Black political power, Jon Ossoff and Ron DeSantis. Among the losers: Donald Trump, Elon Musk and really ugly campaign tactics.
Women, science, and why The Love Hypothesis is the hit Rom-Com of the year
These are times of chaos, these are times of change, but they are definitely times for readers — and now it’s The Love Hypothesis’s turn. When I read this book by Ali Hazelwood a few years ago, it wasn’t that popular to adapt romantic comedies, but major streaming platforms are now treating us to a healthy
Work halts on conversion of shuttered Dearborn hotel after investigation into whether people were living there illegally
Perhaps 100 people had been living in the building over the last year, police were told.
Bradbury Science Museum Presents ‘Night With A Nerd: Neuromorphic Artificial Intelligence Wednesday Nov. 4.
BRADBURY SCIENCE MUSEUM NEWS RELEASE The Bradbury Science Museum will present ‘Night with a Nerd: Neuromorphic Artificial Intelligence’ 6-8 p.m. Wednesday Nov. 4. The community is encouraged t…
Kansas just elected a Democrat. His message to Washington? Be decent
The Methodist pastor who flipped a Republican Senate seat says voters want more than political change. He tells NPR what he heard from Kansans about decency, faith and finding common ground.
macOS 27.3 Brings Live Activities to Macs Without Dynamic Island
The new MacBook Pro models with touch-enabled OLED displays feature the Dynamic Island instead of a notch, and it includes support for Live Activities. Fortunately, other Apple silicon Macs will not entirely miss out, as the macOS 27.3 update enables Live Activities for apps like Apple Music, Clock, and Voice Memos in the macOS menu bar.
FSU Partners With Special Olympics Florida to Expand Access to Health Screenings
Florida State University students and faculty partnered with Special Olympics Northwest Florida to provide accessible health and wellness screenings for individuals with intellectual and developmental disabilities at The Arc Big Bend in Madison, Fla. on Sept. 23. The Healthy Hearing and Strong Mind event brought together audiologists and students from the School of Communication Science…
Lawsuit filed against 'Money out of Politics' proposal after Michigan voters pass initiative
Almost immediately after Prop 2 passed in Michigan, a lawsuit challenging its legality was filed in federal court.
Waystar touts bigger health system wins and growing AI pipeline
Healthcare payment software maker Waystar again outperformed analysts’ estimates in the third quarter as the company builds out new artificial intelligence capabilities and drives growth by adding | Waystar again outperformed analysts’ estimates in the third quarter as the company builds out new AI capabilities and drives growth by adding new customers and selling more of its platform to existing clients.
Why the Grand Canyon May Be Missing 1.2 Billion Years of History
“Sometimes what is missing can tell us more about the story of Earth than what we can see.”
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.
Amy Acton, Annie Andrews and what Democrat wins mean for RFK Jr. and the MAHA movement
While Democrat wins − including several medical doctors − don't point to a complete dismantling of MAHA, experts say tides are definitely changing.
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.
Russia giving some missiles greater range, larger warheads: Ukraine
The new assessment from Ukraine's military intelligence said Russia has stockpiled thousands of ballistic and cruise missiles.
Heisman Watch: Will Julian Sayin's injury ultimately derail Jeremiah Smith's Heisman hopes?
Giants Should Target Senzatela for More Bullpen Depth
Antonio Senzatela offers a versatile solution, bringing starter experience and proven relief stability to stabilize the San Francisco Giants’ taxed pitching staff.
Health Plan Unlocks More Than $10M in Savings in Six Months Using Cohere Health's AI-Powered Pre-Payment Review
Cohere Health®, the leading clinical intelligence and operations platform for health plans, today announced that a Medicare Advantage client identified more than $10 million in savings in six months by finding complex clinical and coding errors in high-cost drug and durable medical equipment claims before payment.
Wednesday Bantering: We’re Definitely Getting a Lockout
So I gather there was an election yesterday? Mark Texiera lost his run for Texas’ 21st district. We don’t talk politics on this site really, there’s enough to shout about just in terms of baseball, but I think we can all agree that the good people of Texas deserve better than a vile Yankee. Former […]
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.
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
CVS to split into two companies, in major breakup of its $117 billion healthcare empire
CVS Health said Wednesday it is splitting into two companies, marking one of the largest shakeups in the healthcare industry. It’s a major reversal of the mergers that brought together the nation’s largest drugstore retailer along with health insurance giant Aetna and pharmacy benefit manager Caremark.
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.
Sanford Health Column: Keeping human connection at the heart of healthcare
When used appropriately, AI documentation can make a visit feel more personal, not less. Instead of dividing attention between a patient and a computer screen, a clinician may be able to focus more fully on the conversation.
MSGE: Revenue rose 37% as live entertainment demand and adjusted operating income strengthened
Q1 revenue rose 37% YoY to $217.1M, with adjusted operating income reaching $34.3M. Management expects healthy live-entertainment demand and robust FY 2027 growth; quarterly share repurchases were approximately $25M.Original document: Madison Square Garden Entertainment Corp. [MSGE] SEC 8-K Current…
Geron Corporation Reports Third Quarter 2026 Financial Results and Recent Business Highlights
Achieved $60.1 million in RYTELO® (imetelstat) net product revenue in Q3 2026, an increase of 5% compared to Q2 2026 Reiterated 2026 RYTELO net product revenue at the mid-to-high end of the $220 million to $240 million range; lowered 2026 total operating expenses range to $220 million to $230 million Initiated gated commercial launch to expand RYTELO access to eligible LR-MDS patients in targeted European markets, with availability expected in Germany by end of year Ended Q3 2026 with cash, cash
Why Nintendo is betting on a nearly 30-year-old game remake to win the holiday
“Saturday Night Live” poked fun at characters from two of the holiday season’s most anticipated video game releases last month: Link from the upcoming remake of “The Legend of Zelda: Ocarina of Time” and Jason from “Grand Theft Auto VI.”
Hidden planet emerges from the glare
Stars are so bright that their glare overwhelms faint nearby planets. Scientists combined detailed physics from telescope observations with modern computational techniques to precisely remove this glare. After applying the tool to existing JWST images, they found a previously hidden giant exoplanet. Technique could improve planet-detection sensitivity without requiring changes to telescope hardware.
Search committee formed to find new Vice President for Research
The committee begins its work immediately and invites members of the Northwestern community to share feedback
HCPSS Teams Up with Student Group to Drive Student Interest in and Understanding of Coding, Computer Science, and Artificial Intelligence
Several years ago, Julie Wray and Carrie Trudden, Howard County Public School System’s (HCPSS) then- and current coordinators of Instructional Technology, began receiving emails from a group called Howard County Hour of Code (HocoHOC). At the time, Wray and Trudden were unfamiliar with the group and skeptical about its offer to partner with the district […]
Sports on TV/radio listings: Nov. 4
Where to watch and/or listen to today's sporting events that will be televised or broadcast on the radio.
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
Expecting a new grandchild? Here’s why you may need to see your doctor first
When a baby is on the way, doctors often recommend that the mother get certain vaccinations to protect her newborn – and it turns out that other family members who may visit the infant, especially grandparents, are urged to be up to date on certain shots, too.
Advito Announces Launch of AI-Enabled Consulting Intelligence Platform
Pilot will roll out through Q1 2027
Watch CNN’s coverage of Election Night in 5 minutes
The 2026 midterms results have revealed a blue tsunami as Democrats take back control of Congress. CNN’s coverage over the night highlights the stunning turn of the tides for Donald Trump’s Republican Party.
Emperor Entertainment Hotel Expects Profit Attributable Of Not More Than HK$35 Million For HY
Emperor Entertainment Hotel Limited HKEX:296:
Troy Jackson topples Republican Susan Collins in Maine Senate race
Democrat Troy Jackson defeated five-term Republican Sen. Susan Collins in Maine, despite only becoming his party’s nominee in July.
Disney has fought AI firms over copyright. Now it’s testing AI lyric videos
Walt Disney Co. is experimenting with using artificial intelligence to test out different concepts for music videos showcasing the lyrics to its songs, starting with “Go the Distance” from its
Google’s Next Big Bet Is a Business It’s Never Won
On October 28, Google told Wall Street something that publishers, small businesses and anyone who’s ever depended on search traffic have been telling
Texas Democrats pull off the breakthrough they’ve chased for decades
For decades, Texas Democrats have dreamt of turning the state blue, rallying around exciting candidates who drew big crowds and big money but could not ultimately overcome the state’s stubborn conservative majority.
Democrat Abdul El-Sayed projected to win Michigan and become nation’s first Muslim senator
What’s next after Trump’s massive miscalculation triggers historic defeat
There’s only way to view the Democrats’ staggering midterm election triumph: It is one of the most colossal repudiations of a sitting president in modern history.
AI boosts operational efficiency but not systemic climate action, global study finds
Artificial intelligence (AI) is widely promoted as a tool for sustainable development, but whether its operational gains translate into deeper ecological transformation remains uncertain. A new global assessment examines how AI diffusion relates to seven core United Nations Sustainable Development Goals (SDGs), covering health, education, clean energy, industry and infrastructure, sustainable cities, responsible consumption and production, and climate action. It also explores the channels behind
Hinge Health (HNGE) Stock Looks Stretched On Its 156% YTD Run
Hinge Health has been one of the stronger movers in digital health this year, and the stock’s sharp climb now puts a spotlight on a simple question for investors: Is the current share price adequately supported by the company’s earnings power? The stock is up 156.5% year to date, which puts a lot of pressure on its earnings profile to justify the enthusiasm baked into today’s valuation. Recent earnings news highlighted stronger profitability and an expanded client base, which can support...
Democrats secure historic majorities in the midterms — and are poised to win even more seats
The party is poised to have strong majorities in Congress for the final two years of President Trump’s term. Follow for live updates.
“I Don’t Know If I’m Willing to Do It Just to Fight” – UFC Fans May Have Seen the Last of Beneil Dariush Inside the Octagon
Fans may have already seen the last of Beneil Dariush inside the Octagon. The veteran lightweight has endured a difficult stretch lately, losing four of his last five UFC fights, with all four defeats coming by knockout. Most recently, Dariush was stopped by Quillan Salkilld at UFC Perth in May 2026. Before that, he suffered …
Trump reacts to Republican losses and declines to take blame
By the time the House and Senate had been called for Democrats on Tuesday, a consensus among members of both parties was forming: voters had rejected President Donald Trump’s record in office, and he would face a starkly different political reality for the remainder of his term.
Flats plan for aparthotel in Reading after business changes
City Wall House's apartments are used less following the pandemic, the building's owner says.
The historic firsts of the 2026 election
Winners up and down the 2026 ballot will make history this year, CNN’s Decision Desk projects, including the first Black woman governor and the first out gay male US senator.
How the Stock Market Is Reacting to the Midterm Elections
U.S. stock futures fell as the first results came in, but later traded higher as investors assessed the outlook for artificial intelligence and other key sectors as the balance of power shifts in Washington.
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.
A jack of all tales: Orville Hicks delights museum annual meeting with stories of Appalachia
JEFFERSON — The Orion Schoolhouse became storyteller Orville Hicks’ front porch on Oct. 20 as he regaled the Museum of Ashe County History’s board members with old mountain tales and
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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