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Tillamook teen wins national FFA title for flower business
Coastal town known for dairy, but students get well-rounded ag education Tillamook, Ore., is known for dairy, but a student from this coastal community won a national FFA title for […]
Don’t trash those campaign signs. Sacramento program keeps them out of the landfill
Community members can head instead to recycling event that helps breath new life into political signs that can’t be recycled.
Israel must not become the scapegoat for America’s political failures
Blaming Israel for America's political failures echoes a troubling history that Christian leaders have a moral obligation to reject.
Sixth measles-associated death recorced in Jefferson County
The state Health Department on Wednesday confirmed that an unvaccinated person in Jefferson County who tested positive for measles has died.
PHOTOS: All Access: The Future of Football is Female
The Seahawks held a two-day initiative designed to create access, opportunity, and leadership pathways for girls and women at every stage of their sports journey.
Gamers go to ridiculous lengths to "improve" GTA VI with Nvidia's DLSS 5
Using a capture card and open source software to run PS5 video through a PC GPU.
These are the doctors and scientists elected in the 2026 midterms
Learn more about the scientific community coming into office in January
Dropbox’s New Tools Will Organize Your Messy Files. Business Owners Could Avoid Hours of Busy Work
Agentic capabilities are coming to Dropbox, the cloud storage platform with more than 700 million registered users worldwide.
Science Lab: Offense vs. defense in Dallas
Welcome to "The Science Lab", a place where football facts and in-depth analysis always triumph over feelings.
Fox Sports to honor America's veterans with NFL, college football coverage live from West Point, Annapolis ahead of Veterans Day
This year, to cap off the country's 250th birthday celebration, Fox Sports is expanding its tradition with special two-day NFL and college football pregame coverage from two of the nation's most-storied military academies.
SOBEWFF® TURNS UP THE HEAT FOR 2027 WITH A STAR-STUDDED LINEUP OF FOOD, ENTERTAINMENT AND NEW EXPERIENCES
Getting your Trinity Audio player ready... The nation’s biggest culinary celebration is back. The Food Network South Beach Wine & Food Festival presented by Capital One (SOBEWFF®) returns February 25-28, 2027, bringing together more than 500 chefs, culinary personalities and industry tastemakers for four days of extraordinary food, entertainment and wine and spirits exclusively provided […]
Walleye Capital parts ways with former stock picking head Anil Gondi
Walleye has had a tough 2026, including a 5.9% loss in October.
Guide to New Orleans live theater and stage shows in November 2026
From uplifting musicals like "Come From Away" to compelling dramas like "Something Cloudy, Something Clear," the New Orleans and northshore stages are set for a diverse and captivating fall season!
The Blue Wave hits Sand Hill Road
Elon Musk, venture capital, MAGA politics, and AI data centers collide as Democrats win big in the Midterm elections.
How Democrats’ midterm gains could reshape the political landscape for AI
Democratic midterm wins could increase scrutiny of AI data centers and power demand, but President Donald Trump retains veto power over any federal legislation.
ASCAP Partners With Project Healthy Minds To Expand Mental Health Services
ASCAP has expanded its Wellness Program with a new mental health member benefit in collaboration [...]
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
Swiss Re seeks alternative capital for hyperscale data centers
Swiss Re AG is in talks with alternative capital providers to cover peak data center losses as capacity falls short of demand from a growing number of hyperscale projects, according to Gianfranco Lot…
Instagram brings Edits to desktop to take on CapCut
The move puts Edits in more direct competition with ByteDance's CapCut, the video-editing app Meta sought to challenge when it launched Edits last year.
Russell & Tuipulotu back for Scotland v All Blacks
Captain Sione Tuipulotu and fly-half Finn Russell return to the Scotland side for Saturday's Nations Championship meeting with New Zealand at Murrayfield.
Oregon was once a Republican stronghold. This politician started shifting the balance in 1954
For much of the first half of the 20th century, Oregon was effectively a one-party Republican state. Democrats had not won a U.S. Senate seat in 40 years, had not won a U.S. House seat in 18 years, and had controlled the state legislature for only four of 74 years since 1880. Into this landscape emerged Richard Neuberger, a Portland-born journalist of Jewish heritage whose prolific writing career, progressive convictions and remarkable personal drive would reshape Oregon politics.
Alaska Science Forum Time Capsule: Bats in the belfry
Note: Ned Rozell wrote this column on Oct. 25, 1994, his first as the new author of the Alaska Science Forum. I’m pleased to feature this time capsule, as it explores one of my favorite questions in biology: How do mammals survive in intensely cold temperatures? Additionally, Ned ended the story with, in my opinion, a perfectly silly final sentence. Ned published an update on Alaska’s little brown bats in 2019: https://bit.ly/bat-update. — Sara Wilbur
Carson Daly joins 'Saturday Today' beside Laura Jarrett, will keep 'Today' job
And on the sixth day, Carson Daly said, "Let there be 'Saturday Today,'" promising to rest on Sunday.
Fairview Health Services Partners with hellocare.ai to Expand Enterprise Virtual Care and Bring Connected Care to the NICU
Minneapolis, MN and Clearwater, FL — Fairview Health Services and hellocare.ai today announced an enterprise partnership to expand virtual care capabilities across Fairview’s inpat | Minneapolis, MN and Clearwater, FL — Fairview Health Services and hellocare.ai today announced an enterprise partnership to expand virtual care capabilities across Fairview’s inpatient environments, including a dedicated deployment designed to connect NICU patients, families, and care teams.
Memorial Health to close one of its Springfield facilities
"We are working with each of the residents and their families to create transition plans, including placements at other facilities if appropriate," said the statement.
The Daily Mauling: 11/5/26
Kansas Jayhawks News The Topeka Capitol-Journal has Leroy Blyden and Tre White’s reactions to the Fordham win Andy Kotelnick talked to the press and gave his preview of this weekend’s UCF game ICYMI, the women’s hoops team won their season opener over Omaha this week Links! Jacoby Brissett is going to try and save Baltimore’s […]
MLB lockout tracker: What CBA talks mean for Phillies baseball
From a proposed salary cap to free agency and playoff changes, follow every development before the current CBA expires Dec. 1.
As she debuts on Broadway, Kailey Boyle praises Madison theater scene
Boyle, a Middleton High School grad, makes her debut in “Wanted” on Broadway this fall. The show opens officially Nov. 8 in New York.
Woods Hole research ship heads to Lake Superior to hunt neutrinos
The R/V Neil Armstrong is making its first Great Lakes voyage, carrying Cape Cod science into fresh water for an experiment probing the universe.
How to nominate for Business Insider's Rising Stars of Venture Capital
We're searching for venture capitalists finding the next big thing and those winning the right to invest in proven winners.
Sporticast: Atlanta Braves Give MLB and Union CBA Talking Points
On the 601st Sporticast episode, hosts Scott Soshnick and Kurt Badenhausen discuss some of the biggest sports business stories of the week, including Mark Walter looking to sell at least part of the Formula 1 racing team he controls at a $3 billion valuation. F1 team values have soared with cost caps introduced and Liberty …
Black-owned businesses impact in Charlotte ‘undeniable.’ New event aims to celebrate it
Marketplace ‘Black on the Block’ arrives to spotlight Charlotte entrepreneurs at Bojangles Coliseum.
You Don’t Need to Be a Gambler to Be on ’Tilt’
The term captures the self-defeating loop of losing and not being able to stop. It also describes doomscrolling, politics and our society’s default state.
Entertainment
Playhouse at McConnellstown has launched its “Raise the Roof” Capital Campaign to raise $30,000 for repairs to the theater’s roof and gutter system. Donations of any amount are being accepted
CVS Health plans to spin off pharmacies, including on Long Island
The company's shares fell 12.5% Wednesday after announcing its plan to separate its pharmacy and insurance businesses.
The U.S. spent 50 years trying to escape oil shocks. They still upend elections.
Even as the energy economy has changed radically, the politics of oil have not.
Official | Bayern Munich extend Harry Kane’s contract until 2029
Bayern Munich have officially confirmed that Harry Kane has signed a two-year contract extension, keeping the England captain at the German record champions until June 30, 2029. The recent Ballon d’...
Red Wings Icon Disturbed by Organization’s Treatment of Yzerman
Steve Yzerman was Henrik Zetterberg’s first captain when he joined the Detroit Red Wings in 2002. Yzerman was his teammate […]
In Warren County, a reflection of rural healthcare's turmoil
Rising costs, staff shortages and plummeting reimbursement rates have shuttered several of Pennsylvania’s rural hospitals, with nearly a third at risk of closure in the coming years.
AI threats challenge cybersecurity landscape
Artificial intelligence is accelerating cybersecurity threats against businesses and government agencies, allowing criminals to potentially impersonate employees, steal sensitive information, and compromise corporate networks faster than organizations can respond, warn some cybersecurity experts.
Houlihan Lokey Expands European Business Services Capabilities with Senior Hire
Houlihan Lokey, a global investment bank, added Adnan Choudhury as a managing director in its business services group. Based in London, Choudhury will focus
Maro Itoje and the art of sports leadership: ‘It’s not a democracy. It’s a benevolent dictatorship’
England's rugby union captain on learning from Mikel Arteta and what a Samurai sword taught him about motivation
TOP 10 PLAYERS: AEK Athens 2–3 Real Madrid
A narrow escape in the Luka Jovic reunion
‘Survivor 51’ recap: Tribe merge madness initiated!
The ‘Survivor 51’ merge madness leads to grub guts, mob boss accusations, and someone possibly urinating all over the tribe camp. Read EW’s recap.
Democrats 'Blue Wave' of victories in midterms to change political landscape
A sweeping night of Democratic victories across the country has left the party poised to take control of both the House and Senate.
Ranked: Major Countries by Share of Graduates in Science and Math
Which countries produce the highest shares of science and math graduates? Explore how major economies compare using UNESCO data.
Democrats make gains in Collin County as voters reshape political landscape
A longtime Republican stronghold saw Democrats make major gains in the 2026 election, even as some GOP incumbents held their seats.
America’s political landscape is shifting -- NBC Nightly News anchor Tom Llamas breaks down midterms
Valkyries parade historic WNBA title through ‘global capital of women’s sports’
The Bay Area showed up and showed out as they showered their championship-winning Valkyries with love Wednesday.
'A mandate for change': Democrats remake Texas politics in election rout
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.
'A mandate for change': Democrats remake Texas politics in election rout
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.
LIV Golf appears officially dead as PE firm drops investment after star players defect
LIV Golf, even in its diminished post-Saudi opulence form, is in dire straits as of Wednesday evening. A new report by Sujeet Indap in the Financial Times indicates that BC Partners, the private equity firm that was prepared to provide LIV with a league-saving capital investment after Saudi Arabia’s private investment fund (PIF) ceased financing the…
In Chatsworth, N.J., Rutgers Scientists Farm for the Berry Best Varieties
During a mostly sunny Friday morning in early October, 11 students squatted in a basin, picking cranberries from low-creeping vines and placing them into clear plastic bags. “Do not eat them,” said Peter Oudemans, a professor of plant biology and pathology with the Rutgers School of Environmental and Biological Sciences. He was sort of kidding – and sort of not.
Mob Entertainment Lays Off 'Almost Entire' Escape From Playtime Team
A former member of Mob Entertainment’s Escape from Playtime Team claims “almost all” staff working on the project have been laid off.
Small Business Saturday set for Nov. 28 in downtown Cape Girardeau
The annual Small Business Saturday in downtown Cape Girardeau is set for Saturday, November 28.
Why a pink potato-like robot is wheeling around Philadelphia
In a city where robots get kicked, graffitied, and decapitated, an artist built a friendlier alternative. Is it enough?
Kraft Heinz is Selling Its Coffee Business. Its Stock is Brewing.
Private equity firm One Rock Capital Partners is buying the operation at an enterprise value of $650 million.
Melco Resorts & Entertainment: Adjusted EBITDA reached $288 million as Macau softness sharpened focus on cost discipline and deleveraging
Q3 adjusted property EBITDA was $288 million, or $298 million adjusted for VIP hold, while Macau demand softened and competition remained intense. Deleveraging and disciplined reinvestment remain priorities; 2027 CapEx guidance was reduced to $275 million.Based on Melco Resorts & Entertainment Q3 2…
Business Aviation Pilot Shares His Inspiring Journey From Line Tech to Learjet Captain
Read the remarkable story of a teen who quickly moved from a job fueling aircraft to a Learjet captain, thanks to hard work, determination and professional relationships.
Kraft Heinz to sell coffee business that includes Jacksonville Maxwell House plant for $650M
Kraft Heinz has agreed to sell its North American coffee business to an affiliate of One Rock Capital Partners for an enterprise value of $650 million, while keeping a 30% stake in the business.
Dan Hurley gives brutal reaction to being given game ball
Say what you will about Connecticut Huskies basketball coach Dan Hurley, but he is never going to win anyone over with a charm offensive. Hurley has been incredibly successful at UConn, but he’s also drawn criticism for his antics and outbursts, especially his treatment of referees. But when it comes to his press conference escapades, Hurley can sometimes…
God of War Laufey delayed three months to May 2027, as Sony Santa Monica escapes a packed February
God of War Laufey has been delayed to May 2027, moving out of a crowded February already filled with Fable, Persona 4 Revival and much more.
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.
I tried Apple's Siri Recaps. They're surprisingly useful — and a little unsettling
Apple's AI-powered Siri Recaps won me over in just one day, despite my privacy reservations. But there's still room for improvement.
Holidays at Disney or Universal? What to do, how to choose
Park Pulse is USA TODAY's weekly guide to what's happening across America's national parks and major theme park destinations, including Disney and Universal.
Commentary: A disquiet follows West Virginia's supermajority
On a night where shocking results dominated election-watching media, U.S. Sen. Shelley Moore Capito, R-W.Va., having her re-election race insta-called was a reassuring respite of routine for a Republican Party having a terrible, horrible, no good, very bad night.
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.
Daughter vows to keep late father’s Camano landscaping business alive
Stanwood-Camano is remembering Francisco “Sisco” Zavala, a longtime landscaper and business owner who died suddenly on Oct. 1. His family will honor him at a memorial on Saturday, Nov. 7,
Rome's Cinema Capitol to Reopen in January After 2024 Tornado Damage
The Capitol Arts Complex is preparing to reopen its independent cinema after being closed for repairs following tornado damage.
Kraft Heinz to divest its North American coffee business in $650 million deal
Kraft Heinz will divest its North American coffee business to private equity firm One Rock Capital Partners as CEO Steve Cahillane works to revive the company.
New Research Tests Whether AI Models Know Their Own Thoughts
By injecting “thoughts” directly into large language models, researchers are trying to map out AI’s capacity for introspection.
Melco Resorts & Entertainment: Disciplined spending and lower CapEx anchor plans amid softer Macau demand
Q3 adjusted property EBITDA was $288 million, while Macau demand softened in October amid broader China economic weakness and intense competition. Deleveraging and disciplined reinvestment remain priorities; FY2027 CapEx guidance fell to ~$275 million.Based on Melco Resorts & Entertainment Q3 2026…
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.
Voya Financial Expands its Multiple Employer Solutions as Business Nearly Doubles
WINDSOR, Conn., November 04, 2026--Voya Financial, Inc. (NYSE: VOYA) today announced new capabilities that will expand its Multiple Employer Solutions (MES) business, giving employers, workers and advisors more choice and a simpler experience. Voya’s MES business serves a wide range of organizations, including industry associations, faith-based groups, public sector entities, professional employer organizations and small-to-middle market businesses.
USC political science expert breaks down S.C. elections
South Carolina voters reshaped the state’s political landscape Tuesday night.
Mets Morning News: More salary cap nonsense
Your Wednesday morning dose of Mets and Major League Baseball news, notes, and links.
Braves News: Salary cap proposal, Rolddy Muñoz review, and more
Atlanta Braves news and notes from Tuesday.
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.
Reps grill auditor general over Health Department oversight lapses
Less than 1% of Michigan Public Health Institute spending reached universities
Antoine Frérot Publishes a Book to Reconcile Business and Society
Antoine Frérot publishes 'De l'entreprise en démocratie' with Flammarion. A call to reform financial capitalism and focus on long-term value creation.
‘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.
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 […]
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.
Fit Tips: The science of recalling your forgotten glutes
To fix gluteal amnesia (or “dead butt syndrome”), you need to stretch tight hip flexors and retrain your brain to fire your glute muscles using targeted activation exercises. Movement is how you remind your glutes what they’re capable of doing.
Why big mergers aren’t in Inova’s playbook
Inova President and CEO Dr. J. Stephen Jones outlined the system's growth plans and capital project strategy.
Pens Points: Penguins blow another one with late-game collapse
Here are your Pens Points for this Wednesday morning… The Pittsburgh Penguins fell 3-2 to the Vegas Golden Knights on Tuesday night after special-teams struggles cost them another game, as they failed to capitalize on key power-play opportunities, including a lengthy two-man advantage in the third period. [Recap] NHL Commissioner Gary Bettman said he is […]
Bobby Brown Returns to CSA to Drive Defense Business Growth
The former Astrion and Cubic executive brings Navy, missile defense and space capture experience back to the company.
Juventus to Get More Cash from Owner, Outline Priority
Juventus have announced yet another capital increase of up to €250M, to be activated in due course. They were in the red by €66M in the last session. The stakeholders will have to pour more money ...
Raphinha to sign new Barcelona contract until 2030 on Thursday
Barcelona captain Raphinha is expected to formalise his contract renewal on Thursday, November 5, signing a new agreement that will keep him at the club until 2030. According to SPORT, the agreement ...
Arizona voters poised to approve restrictions on transgender athletes
A ballot measure that would restrict transgender athletes from participating in girls’ sports appeared headed to approval Tuesday night.
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.
Nebraska men’s golf fall season recap
Sports writer Connor Krumme describes the many highs and lows that have occurred throughout the Huskers’ latest golf season.
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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