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Learn About Quantum Networks at PubSci Science Cafe Nov. 18
Learn about quantum networks at the next PubSci, a science café presented by Brookhaven National Laboratory, on Wednesday, November 18 in Smithtown.
From 'Dune' to 'Godzilla,' movie popcorn buckets are getting bigger and stranger — that's kind of the point
Elaborate movie-themed popcorn buckets are becoming a major moneymaker for theaters. An expert explains why fans are embracing the unusual souvenirs and how they're changing the moviegoing experience.
Innovations for Women’s, Children’s and Adolescents’ Health in Climate and Humanitarian Contexts
Climate change and humanitarian crises are placing growing pressure on essential health services for women, children and adolescents. As part of the Advocacy Forward series, PMNCH is convening an online workshop to explore practical, evidence-based innovations that strengthen service delivery in crisis-affected settings. Participants will gain tools, insights and advocacy strategies to support resilient, inclusive health systems and identify opportunities for collaboration, adaptation and scale.
‘Collaborative effort’ coming for Michigan Football’s offensive play calling
Kyle Whittingham spoke about the “collaborative effort” that will take place with offensive play calling on this week’s Inside Michigan Football radio show:
The business of healthcare takes center stage at annual conference
Registration is now open for marquee event that sparks collaboration, learning and relationship-building.
The business of healthcare takes center stage at annual conference
Registration is now open for marquee event that sparks collaboration, learning and relationship-building.
Collaborating to unlock new business models in the food system
Explore how food value chains can share risk, align commercial incentives, and scale durable business models through collaborative investment and finance.
PLOCAN Hosts Canary Islands Fisheries Delegation to Explore Ocean Science Collaboration
PLOCAN hosted a Canary Islands Government fisheries delegation at its Taliarte facilities, covering topics ranging from offshore wind energy and aquaculture to marine robotics, ocean observation, and AI-driven vessel identification. The visit concluded with a tour of PLOCAN's underwater vehicles laboratory.
The Health Financing Crisis Demands Innovation: Lessons From Pooled Sputum Testing For TB
At a laboratory in Cameroon, technicians receive sputum samples from people suspected of having tuberculosis (TB). Until recently, each person’s sample
St. Louis Cardinals Center Field Target: Luis Robert Jr
We’re only 22 days away from the Owners locking out the Players in the major labor dispute that has loomed over the sport for the last 18 months. Chaim Bloom, newly minted GM Rob Cerfolio, and the St. Louis Cardinals front office have a very limited window to operate to improve the big league roster […]
Ecologies of Collaboration: Art–Science Methodologies in the Arctic
Transdisciplinary collaboration evolves through shared learning, practical strategies, and effective tools.
San Juan County businesses upbeat but strained by labor, housing and ferry costs, survey finds
EDC report draws on responses from 62 businesses across San Juan, Orcas and Lopez islands
SAP Expands Collaboration with AstraZeneca to Adopt RISE with SAP and Business AI
WALLDORF — Cloud, data and AI create a stronger foundation for innovation at scale.
ECU Notes: Golden LEAF helps ECU grow pipeline of clinical laboratory scientists
Clinical laboratory scientists can be described as “behind the scenes” healthcare professionals, yet they are essential to patient care.
Mastercard (MA) Expands Its Business Banking Reach Through New Partnerships
Mastercard (NYSE:MA) is expanding its business banking reach through new partnerships focused on commercial cards and treasury tools. BMO and Mastercard launched the BMO CashBack World Elite Business Mastercard in Canada, targeting small and midsize firms with rewards and protections. Citizens Treasury Intelligence™ went live through a collaboration between Citizens and Trovata, using Mastercard technology to support corporate treasury management. The BMO CashBack World Elite Business...
Usher’s New Look nonprofit has supported more than 50,000 young people, and its 2026 partnership with BET is helping new talent gain experience in the entertainment industry
Usher’s New Look, the national nonprofit organisation advancing economic mobility through entertainment careers, has served more than 50,000 young people worldwide, and its 2026 partnership with BET and Boys & Girls Clubs of Greater Detroit is helping new talent gain hands-on experience in the entertainment industry. Announced in August 2026, the collaboration aims to expand career pathways into the sector for young people and to develop the next generation of entertainment leaders.
Business, labor coalition voices support for data centers
More than two dozen Valley businesses and labor groups are joining together to change the narrative surrounding data centers.
Newest Sample, Oldest Rock?
Written by Tasha Coelho, Mastcam-Z Student Collaborator at Arizona State University
Michigan football starting quarterback vs Oregon? 'To be determined'
"You can't do major changes at this juncture, and so it will be collaborative," Michigan football coach Kyle Whittingham said Monday, Nov. 9.
Medicare Fee Schedule for 2027 Favors Psych Collab Care Models
Behavioral health services, including the psychiatric collaborative care model (CoCM), received rate increases from the Centers for Medicare &
Cerabyte to Address Future of Data Storage for HPC and AI at SC26
Cerabyte Joins Los Alamos National Laboratory to Discuss Storage Innovation SANTA CLARA, Calif. and CHICAGO, Nov. 9, 2026 — Cerabyte today announced that it will join experts from Los Alamos National Laboratory for a panel discussion at Supercomputing 2026 (SC26). The experts will examine how industry consolidation, limited investment in long-cycle research/development and growing AI […]
At Somos, politics and real estate enter a new reality
The annual Somos conference at the Caribe Hilton in San Juan brought together political animals, real estate heavyweights and labor leaders, making for a heady brew of interests vying for top priority across City Hall, Albany and even Washington policy agendas. Dealmakers of every stripe congregated at the hotel’s Caribar — successor to the hotel’s Beachcomber Bar where the piña colada originated — for impromptu meetings and tipsy policy chats, while lobbyists clustered at tables on the patio to arrange agenda-setting sitdowns. Somos attendees looking to unwind away from the conference gravitated to the swanky Fairmont El San Juan Hotel […]
Could the way we walk give clues about our mental health?
Experts in kinesiology and sport sciences and psychology from the University of Miami are collaborating on research to find out whether the way people walk could give clues about their mental health. ...
Estée Lauder Companies Expands Focus on Skin Longevity Science
The Estée Lauder Companies has announced the creation of
Media Link, Inc. celebrates 25 years in business
Media Link, Inc., a full-service marketing, advertising, and software development agency based in Rock Island, recently celebrated its 25th anniversary. Founded on Oct. 24, 2001, the agency now reaches a quarter-century milestone rooted in transparent client partnerships, adaptable strategies, and a collaborative team culture. The agency is located at 1902 17th St. This year also […]
Rahway's Roosevelt Elementary Third Graders Put Science into Action with Hands-On Pumpkin Investigation
RAHWAY, NJ — Third-grade classrooms at Roosevelt Elementary School wrapped up their science unit on life cycles this week by turning their desks into active scientific laboratories. Students from...
There’s more than a whiff of politics to the sudden call to slash Labor’s green energy subsidies
EVs and home batteries are in Treasury crosshairs despite a better economic case for scaling back nuclear-powered submarines and diesel fuel rebates for miners
Collaborative research: the beating heart of FP10
Read the latest news and analysis from Science|Business.
Editas Medicine Announces Third Quarter 2026 Results and Business Updates
Company received HREC approval to initiate Phase 1/2 Strive™ study of EDIT-401 in patients with hyperlipidemia in Australia New preclinical data presented at AHA Scientific Sessions demonstrating ≥90 percent LDL-C reduction maintained over 10 months supports EDIT-401's potential best-in-class profile Second IND/CTA accepted for CD70 HD Allo CAR T program as part of collaboration with Bristol Myers Squibb, triggering milestone payment to Editas Cash runway into second half of 2028, through and be
The Unfinished Business of American Socialism
For generations, Democrats have borrowed socialism’s most workable ideas. Now Silicon Valley has taken up its dream of a world beyond wage labor.
Owner of restored Akron Fulton Airport terminal asks $4M — and a buyer who’ll cherish it
The current owner restored the building as a labor of love and wants someone to care for its future.
Orchard’s First Fruit
Well, well, well - ask and ye shall receive. From a few weeks ago: I don’t see anything distinct for Orchard customers yet, so either they’re not live or not distinguished as easily as Garden Plot Eight days later, my wish was granted! Epic’s public FHIR endpoint directory added an organization called Enterprise Orchard Shared Services (Epic org ID 38769) managing an endpoint named “PA Health Center Technology Alliance,” along with 36 facilities under the same brand: The Alliance’s main office 18 Union Community Care sites 11 Delaware Valley Community Health sites Six Community Health and Dental Care sites Off to the races we go! As far as I can tell, no trade publication or Epic has covered this yet - the only public traces I see are a PACHC annual report plus a few patient FAQ pages. I’m not sure why - I think it deserves way more attention! We learn who’s actually buying (and it isn’t who Epic pitched at UGM) We get yet another entry in Epic’s playbook for reaching the low end of the market We get a census of who Epic is coming for next Grab a basket and let’s start picking. An Unexpected Harvest When Epic announced Orchard at UGM 2025, the pitch was a dedicated instance for practices of 80 to 180 providers while keeping the prewired third party applications that make Garden Plot appealing. But the first customer to surface is not that profile at all! Instead, we see something entirely different and arguably more valuable to Epic. The Alliance is a subsidiary of the Pennsylvania Association of Community Health Centers (PACHC). As I wasn’t totally familiar myself, let’s add some quick background for readers who operate outside the safety net: Federally qualified health centers (FQHCs) are community clinics funded under Section 330 of the Public Health Service Act t They serve patients regardless of ability to pay, which results in a payer mix heavy on Medicaid / the uninsured As you might expect, this often results in margins too thin to fund an enterprise EHR on their own (especially in the current very tough funding environment) Every state has a primary care association (PCA), funded in part by HRSA, that supports its FQHCs with advocacy and shared services PCAs have historically been trade associations, so this move is notable in that PACHC is morphing itself into something closer to a holding company. In October 2024, its board voted to form the Alliance to contract directly with Epic and run a statewide technology hub for health centers of any size. A second subsidiary, the Pennsylvania Community Care Collaborative (PC3), is a clinically integrated network of 28 health centers built for value-based contracting. CEO Shelley Riser runs both PACHC and the Alliance and calls the arrangement a “family of companies.” From the latest annual report: PACHC is the only Primary Care Association in the nation with a wholly owned subsidiary directly contracting with Epic. Why does this matter way more to Epic than a single 120-provider group ever could? One contract may only bring in three health centers and 35 sites on day one, but every other PACHC member sits in the pipeline. Moreover, the distributor is an organization those health centers already trust, funded to serve them and literally governed by a board of their own CEOs. And if that wasn’t enough, every state has one! Grafting onto the Safety Net
Heated Rivalry Fans Get Massive Surprise With Elaborate 3 Project Reveal
Fans of Heated Rivalry have spent months hunting for clues about the show’s future. New reporting now confirms the wait was worth it, because Crave’s hockey romance is expanding far beyond a single ne...
UMN art-science installation redefines success through algae and lichen
Exploring the intersection of art and science, a collaborative University of Minnesota project proves that the planet’s most resilient role models might be the ones people overlook every day. Inspired by the slowness, flexibility and omnipresence of terrestrial algae and lichen, Artist-in-Residence Diane Willow collaborated with scientists Daniel Stanton, Beatriz Baselga-Cervera and Daniel Keefe to...
High Impact Optical Partners Make Commitments at Global Summit for Eye Health
ST. JOHN’S, Antigua and Barbuda—Last week, the inaugural Global Summit for Eye Health drew more than 40 governments to St. John’s to tackle the challenge of avoidable vision loss worldwide. Convened by the International Agency for the Prevention of Blindness (IAPB), hosted by the government of Antigua and Barbuda, and co-hosted by the governments of Bangladesh, Guyana, Ireland and Nigeria in technical collaboration with the World Health Organization (WHO), the Summit met its goal with more than $1 billion committed globally to improve access to eyecare screening, spectacles and treatment.
Collaborative research: the beating heart of FP10
Read the latest news and analysis from Science|Business.
Kai Cenat Collabs With Michael Jackson Impersonator Looze Cannon
Kai later revealed hohw much money he made from TikTok during the collaborative stream.
KCPL Beyond Business event to feature nonprofit leaders for conversation on local needs November 12
As the holiday season and year-end giving period approach, the Kenton County Public Library’s Small Business Resource Collaborative will bring community members together in November for “Beyond…
NMSU Physical Science Laboratory marks 80 years of aerospace, defense research
NMSU's Physical Science Laboratory celebrates 80 years, tracing its evolution from White Sands rocket testing to modern aerospace and defense research.
South Texas Health System (@stxhealthsystem)
Investing in Tomorrow’s Healthcare Workforce: With healthcare occupations projected to generate approximately 1.9 million job openings annually through 2035, according to the U.S. Bureau of Labor Statistics, preparing the next generation of healthcare professionals has never been more important. Recognizing the critical role education plays in workforce development, South Texas Health System continues to invest in local colleges, universities and nonprofit organizations that help cultivate future healthcare professionals, including the Texas A&M University Higher Education Center at McAllen (@tamumcallen). As part of its longstanding partnership with Texas A&M University, STHS has once again contributed $5,000 to the university's McAllen campus. The donation will support the campus' Bachelor of Science in Nursing program, which launched in January 2026, while helping students pursue careers in healthcare. This marks the third consecutive year STHS has provided financial support to the Texas A&M University Higher Education Center at McAllen. The contribution will help offset educational expenses through scholarship opportunities while supporting efforts to expand allied health programs and enhance workforce training initiatives designed to meet the growing healthcare needs of the region - @stxhealthsystem on November 7, 2026
‘Paychecks just gone’: Jake and Spike question Seattle’s business costs as Homegrown prepares to close
Homegrown’s impending closure prompted Jake and Spike to question how restaurant owners can survive rising labor and food costs in Seattle.
Labor Unions Won Big on Election Day, With Ballot Initiatives and Friendly Politicians
From the East Coast to the Midwest to the West, unions are celebrating.
Ben Roberts-Smith collaborates with gym business run by influencer that sold ‘war crimes’ pre-workout supplement
Zero Limits supplements is co-owned by right-wing podcaster and fitness coach Chris Katelaris, also known as ‘Big Chocky’
NMSU’s Physical Science Laboratory marks 80 years of innovation
Eighty years ago, a partnership between New Mexico State University and what was then known as the U.S. Army’s White Sands Proving Ground helped launch what would become one of the university’s...
Meta introduces Spaces, a new way to collaborate with your Muse agent
Meta's Muse agents continue to get new features and integrations. Spaces promises to be a new way to interact with the AI helpers.
Mental health crisis response reforms on table in Berkshires
In 2022 and again this January, young men of color were shot to death by police in Berkshire County while experiencing mental health crises. In both cases, law enforcement in Pittsfield and Hinsdale were legally exonerated. Since then, calls for reform have mounted. Massachusetts State Senator Paul Mark was part of a public conversation on the future of behavioral health support and collaborative crisis response. He spoke with WAMC's Berkshire Bureau Chief Josh Landes.
New Animal Health and Food Safety Lab Opens in California’s Central Valley
A new $108 million animal health laboratory in Turlock, run by UC Davis and CDFA, will help California farmers and veterinarians detect potentially dangerous animal diseases more quickly.
Patriot Support Programs of UHS and Wounded Warrior Project Join Forces to Connect Veterans with Specialized Behavioral Healthcare and Ongoing Support - Florida Hospital News and Healthcare Report
Collaboration creates a connected continuum of care and long-term support tailored to the needs of Veterans, Service members and their families. November 4, 2026 — Universal Health Services’ Patriot Support Programs […]
UC Davis completes $108M renovation of animal health and food safety lab
The new 44,000 square foot lab replaced the previous 5,000 square foot lab and now can accommodate large animals.
Friends and Neighbors Invited to Shape the Future of Health in Our Community
Thurston County Public Health & Social Services (TCPHSS) welcomes you to attend the Collaborative CHIP Workshop on November 20, 2026.
Cerabyte Completes S3 Integration Testing in Collaboration with CERN openlab
EIC-supported project demonstrates ceramic data storage within established object-storage workflows MUNICH, Nov. 6, 2026 — Cerabyte, a pioneer of ceramic-based data storage solutions, has announced successful S3 integration testing of its ceramic data storage technology in collaboration with CERN openlab, CERN’s public-private partnership for accelerating computing innovation for science. Supported by the European Innovation Council’s EIC […]
United Methodist pastors report slight health improvements in survey
Duke Clergy Health Collaborative researchers cite GLP-1s and reduced congregational conflict as reasons for lower burnout and obesity rates.
Eva Shriver-Kealoha ‘30 makes her mark with new henna business
In third grade, Eva Shriver-Kealoha ‘30 would doodle skeleton hands on herself and her friends with a ballpoint pen. Now, as a first-year college student, she has turned that childhood hobby into a side hustle, creating elaborate henna designs through her new on-campus pursuit, Dyed Skins by Eva. Originating in North Africa and the Middle...
Obituary: Jonathan 'Jon' Hurwitz, longtime Pitt political science professor, dies at 71
Jon Hurwitz and Mark Peffley could have been competitors when they met as graduate students at the University of Minnesota. Instead, they became collaborators,...
Nicola Fusco on the People, Science and Collaborations Behind IEO’s R&D
Nicola Fusco on the People, Science and Collaborations Behind IEO’s R&D / Bottiglieri Luca, cancer, clinical pathology, Davide Vacirca, Elena
The nation’s cartoonists on the week in politics
Every week political cartoonists throughout the country and across the political spectrum apply their ink-stained skills to capture the foibles, memes, hypocrisies and other head-slapping events in the world of politics. The fruits of these labors are hundreds of cartoons that entertain and enrage readers of all political stripes. Here's an offering of the best of this week's crop, picked fresh off the Toonosphere. Edited by Matt Wuerker.
ASCAP Unveils Mental Health Initiative for Songwriters
ASCAP has unveiled a mental health initiative for songwriters via a new collaboration with Project Healthy Minds.
Family carnival business struggling with inflation and labor shortage
Blake Huston runs a third-generation traveling carnival, but soaring fuel, labor, and insurance costs are threatening the family business. Half of U.S. carnivals have closed in nine years. NBC News' Christine Romans reports.
Vandalia Health, osteopathic school to reopen labor, delivery services at Greenbrier Medical Center
Greenbrier County families will again have access to labor and delivery services through an agreement between Vandalia Health and the West Virginia School of Osteopathic Medicine.
UL Solutions Collaborates on Cross-Industry Initiative to Modernize Life Science Regulated Training
NORTHBROOK, Ill.--(BUSINESS WIRE)--Nov 5, 2026--
Influence Media Partners completes acquisition of Anthem Entertainment’s catalogs in deal valued at over $600M
The deal was struck in collaboration with funds and accounts managed by BlackRock, as confirmed by an announcement today (November 5)…
Harbor District Receives Concept Ideas for the Pillar Point Ocean Science Center While Looking Towards Public-Private Partnerships for Collaboration and Funding
Harbor District Receives Concept Ideas for the Pillar Point Ocean Science Center While Looking Towards Public-Private Partnerships for Collaboration a
SETI and Fermi Paradox Are Nextdoor Neighbors of ID
What do SETI researchers, usually atheists or agnostics (cf. Jill Tarter as an example of the former, Carl Sagan of the latter), want to find? Evidence of MIND.
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 [...]
Danish comedian unwittingly stars in elaborate TV prank
Danish comedian Rasmus Wallbridge spent four months thinking he was making a feature film with his creative partner.
Danish comedian unwittingly stars in elaborate TV prank
Danish comedian Rasmus Wallbridge spent four months thinking he was making a feature film with his creative partner. It turned out to be an elaborate TV prank filmed with hidden
TwinkleTwinkleStar announces strategic collaboration with U.K.-based Ventola Projects to transform party room entertainment
TwinkleTwinkleStar announces a strategic collaboration with Ventola Projects Ltd., a United Kingdom-based specialist in LED lighting, immersive technology, audiovisual solutions, and entertainment …
Oak Ridge National Laboratory, IBM And AMD Launch New Co-Design Platform for Quantum Error Correction
IBM, Oak Ridge National Laboratory’s Quantum Science Center and AMD unveiled a joint platform integrating quantum and HPC.
Las Vegas tattoo artist builds business by prioritizing art over price
The longtime Las Vegas tattoo artist says customer service, collaboration and a focus on artistic quality help his downtown shop compete with bargain-priced rivals.
How Ron Nirenberg prepared to become Bexar County Judge
While Ron Nirenberg's job may be different, his approach will be the same. The former mayor will lean on collaboration in his new role.
When papers become currency: a Chinese debate about trust in science
Last Saturday, 31 October, I went to the University of Hong Kong’s Beijing Centre for its Talent Forum. It was the fourth stop in the series this year, following events in Shanghai’s Zhangjiang, Shenzhen’s Qianhai, and on HKU’s main campus. The programme covered a remarkable distance in one afternoon. HKU’s Xiao-Jing Wang discussed computational neuroscience, intelligence, and the prefrontal cortex—before even delivering his inaugural public lecture to students back in Hong Kong. His colleague Bing Zhang took us from the Big Bang to artificial intelligence. Tsinghua’s Xue Lan asked how AI might reshape the institutional infrastructure underpinning higher education. There were lively panels featuring industry leaders from JD.com, Xiaomi, Haier—and Kaiser Y Kuo on the closing panel discussing innovation and international connections. I cannot pretend to have followed every detail of the brain models or the astrophysics. The talk that stayed with me was closer to something we have covered before: Zhou Zhonghe 周忠和 on papers, evaluation, and scientific trust. Zhou is a palaeontologist, an Academician of the Chinese Academy of Sciences, and an international member of the US National Academy of Sciences. He is also editor-in-chief of The Intellectual (知识分子), China’s leading science commentary platform. His subject was uncomfortable enough for a room full of successful academics: what happens when the system for recognising good science starts rewarding something else? Part of my interest came from our sister newsletter, The East is Read, which covered the controversy around “Geng Tongxue” in May. A PhD dropout from Beihang University, Geng has publicly challenged papers by prominent researchers through detailed online allegations of manipulated images and fabricated data. At Tongji University, an investigation into a challenged Nature paper found academic misconduct, and the dean of its life sciences school was removed. The affair brought doubts about academic integrity well beyond laboratories and university committees. How could someone outside the established hierarchy spot problems in papers that had passed through prestigious journals and institutions? And what, exactly, had all that prestige guaranteed? Zhou approached these questions through two essays published in July by The Intellectual: one by Wang Xiaodong, director of the National Institute of Biological Sciences, Beijing, and a response by Wang Liming, of Shanghai’s Shangsi Institute of Natural Sciences. Both began with the controversy over Geng. Their arguments deserve a wider audience, so I want to put parts of them alongside what Zhou said on Saturday. Wang Xiaodong’s starting point is evolution. A research system selects for the behaviour it rewards. Grants, jobs, journals, talent programmes, and prizes collectively determine which scientists prosper and which practices get passed down from advisors to students. “Whatever the system rewards is what it will evolve to produce,” he writes, citing the ancient Chinese saying: The King of Chu loved slender waists, and many in the palace starved to death. That is a more demanding diagnosis than saying there are dishonest people in science. Punishing a fraudster does not change the selective environment that made a particular kind of research profitable. His account also gives scientific success an awkward role in the story. As Zhou put it on Saturday, science became a victim of its own success. Once research became central to industry, national power, and economic growth, universities and laboratories expanded, and public money followed. That created an administrative need for rapid decisions: who should get the next grant, the next laboratory, the next appointment? The difficulty is that the true value of a discovery may take years or decades of testing and building to become clear. Resource allocation cannot wait that long. Publication counts, journal prestige, impact factors, and citations therefore become convenient ways to make an instant judgement. “The real problem is not that these indicators have no value,” Wang Xiaodong writes, “but that they are trying to answer a question that only time can answer.” Telling administrators simply to stop counting papers will never be enough. They still have budgets to distribute and appointments to make. Something has to replace the shortcut. Zhou described the consequences inside publishing. Papers acquire ever more requirements: a complete story, polished presentation, extensive datasets, and accessibility to readers beyond the immediate field. Individually, those demands sound reasonable. Together, he warned, they produce formulaic “eight-legged” papers 八股文 and rigid reviewing, while genuinely original or non-consensus work struggles to get past journal editors—some of whom wield immense gatekeeping power despite having limited laboratory experience themselves. Meanwhile, the demands for sprawling, “complete” narratives have fuelled a wider replication crisis. Wang Xiaodong uses a mahjong metaphor to describe the result: put the complex papers published by the exact same lab over several years side by side, and they often look like “Thirteen Orphans” (十三不靠)—every tile completely unrelated to the next, and none of them reproducible by outsiders. Zhou also spoke frankly as an editor who has trouble finding reviewers. Everyone wants someone else to review their work; qualified senior researchers have little time to return the favour. The labour is anonymous, unpaid, and brings almost no institutional recognition, so it increasingly gets passed down to postdocs and graduate students. And while anonymity protects reviewers from rank and personal favours, hyper-specialisation means an author’s most qualified reviewer is often a direct competitor, shielded from accountability. The protection and the problem coexist. Wang Liming takes the argument a step further. The decisive change, in his essay, is the instant conversion of academic honour into material resources. Once a paper can be cashed in for funding, a job, students, commercial investment, or even a company valuation, scientists are alienated from their work: they must keep minting this “research currency” to keep their teams alive. He is careful not to romanticise the past. The old world of gentleman scientists—financially independent figures like Boyle and Darwin who needed nothing from external funders—was also a closed club that excluded people without inherited wealth, women, and much of humanity outside the West. Professional science allowed ordinary people, himself included, to become researchers. Nobody should want to undo that. The problem, in his account, is an exchange system that becomes too uniform and too difficult to correct. His most pointed Chinese example is the “hat” (帽子): the prestigious talent designation that brings continuing access to money, laboratory space, students, and institutional influence. “If papers are the circulating currency of the research system, then a ‘hat’ is a bond that pays interest over the long term,” he writes. A paper at least requires another round of peer review. A title in the Chinese context can lock in a judgement made years ago and turn it into permanent status rent, regardless of whether its holder is still doing good science. Here, official institutions hire, organise, and evaluate scientists. Unlike honours awarded by autonomous academic communities in the West, a Chinese “hat” blends non-scientist administrative power with state authority. Once granted, it turns a past judgement into permanent status rent that is nearly impossible to revoke—because taking a hat off would imply that official authority erred in putting it on. Both Wangs see China as experiencing, at compressed speed, pressures present across global science. Research expansion, rising investment, publication growth, and elaborate evaluation metrics arrived in China within two or three decades rather than two or three centuries. Zhou agreed with that international framing—noting that recent US White House science policy documents and the new president of the US National Academy of Sciences, a fellow palaeontologist who recently visited Zhou’s institute in Beijing, have raised strikingly similar warnings about consensus-bound peer review, short-term project grants, and the replication crisis. Still, Zhou emphasised that China’s traditional hierarchy, personal networks (guanxi), and the ethos that “a good scholar becomes an official” (学而优则仕) amplify those pressures at home. So what would change things? Here Zhou’s tone differed from the call for a revolution in scientific trust in Wang Xiaodong’s essay. As an evolutionary biologist, Zhou favoured patchwork repair (修修补补). Living systems survive through accumulated adjustments; dramatic mutations are usually fatal. Science cannot return to a small, slow-moving pastoral era, especially after the successive accelerations of professionalisation after the Second World War, the internet, and now artificial intelligence. But it can alter the local environment in which researchers work. He pointed to domestic experiments designed to support unconventional research and diversify funding, including Tencent’s New Cornerstone Investigator Program, the Xplorer Prize, and the Future Science Prize. He also mentioned participating in reviews for “major non-consensus projects” under the National Natural Science Foundation of China. One guiding principle he recalled was wonderfully direct: “Failure is allowed; corruption is not” (允许失败，不允许腐败). That distinction would mean quite a lot if taken seriously. An honest attempt that fails should not have to disguise itself as a success to survive an assessment. Wang Liming’s essay adds a sharp caveat to the optimism about new domestic funders. Multiple organisations do not automatically produce multiple ways of judging science. If the same pool of senior domestic scientists makes the decisions through the same two-round review procedures, it is still “fake diversity.” He argues for three distinct kinds of money: broad baseline funding governed by fair procedures; patient funding for questions that take ten years; and non-consensus funding based on individual taste, deliberately empowering a few genuine experts to make biased, contrarian bets on eccentric ideas that would inevitably be averaged out by a committee. Replacing one monopoly with another achieves little; a healthy ecosystem needs variance. Zhou’s proposals for publishing were similarly concrete: strip papers of their resource-allocation burden and return them to recording discoveries and establishing priority; separate dissemination from evaluation, as eLife and Peer Community In do; adopt more modular “micro-publications” and real-name endorsements; recognize the labour of editors and reviewers; and give replication work proper credit rather than treating it as an unpublishable dead end. AI makes every part of this debate more urgent—and Zhou wove it throughout his talk. In his own preparation, he used AI to survey the declining influence of academic monographs, noting how tools are already changing how scholars gather information. More fundamentally, he placed AI as the latest great acceleration in scientific history: just as the internet sped up the pace of research and tightened external resource pressures, AI is compressing the cycle again. In the essays Zhou cited, AI cuts both ways. Wang Xiaodong expects large language models to erase much of the English-writing disadvantage long faced by Chinese scientists, further swelling the flood of papers coming out of Chinese labs. Wang Liming sees AI accelerating both ends of the trust crisis: it lowers the cost of paper mills and fabricated images just as quickly as it lowers the cost of automated image forensics, data auditing, and code reproduction. “Whoever builds the verification layer wins,” Wang Liming writes. His proposed alternative to the static, packaged “story paper” is a continuously versioned “unit of discovery” containing a falsifiable claim, raw data, analysis code, experimental parameters, and an ongoing log of independent checks—where negative results and failed replications are recorded rather than buried. Zhou ended his keynote by bringing AI back to the question of scientific honour and credit. Citing a recent Intellectual discussion on “What AI Means for Mathematics” featuring Fields Medalist Deng Yu 邓煜—at a moment when AI is already batch-solving mathematical conjectures, as HKU Vice-President Lin Chen noted in his opening remarks—Zhou agreed that human researchers must remain the principal agents: AI is a tool that frees scientists from tedious calculation to think about deeper, messier real-world problems. Yet that partnership creates a thorny new evaluation problem. When a breakthrough is made with AI, what is the human contribution and what is the machine’s? And since AI models distil centuries of accumulated human scholarship, is it right that the credit and value flow so heavily to the private AI companies building the tools? The old struggle over how to assign scientific honour is acquiring a whole new layer. What I took away was a serious discussion of how science can remain trustworthy as its scale, incentives, and tools change. These were scientists with real standing inside China’s system questioning how that standing is produced, and proposing changes that would affect their own institutions and peers. That made the afternoon at HKU’s Beijing Centre worthwhile. At the close, Wang Feng, Director of Communications and Public Affairs at HKU, said the value of the forum series—which heads to Hangzhou in December and cities like Chengdu early next year—would lie in the real cooperation it helped bring about. The university has plenty to celebrate: this week it topped the QS Asia rankings for a second consecutive year, alongside its 11th-place position in the QS World University Rankings 2027. For me, bringing this debate to an audience beyond the people who review papers and allocate grants was a useful contribution. Share [ The East is Read PhD dropout’s exposé forces an academic fraud reckoning in China A former doctoral student turned blogger has shaken China’s academic establishment by publicly accusing prominent university scholars of fabricating data and manipulating papers, triggering investigations at several leading institutions and drawing rare attention from state media… Read more 5 months ago · 43 likes · 8 comments · Yuxuan JIA ](https://www.eastisread.com/p/phd-dropouts-expose-forces-an-academic?utm_source=substack&utm_campaign=post_embed&utm_medium=web&embedding_publication_id=47580)
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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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