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The Growing Utility of LIBS in Science
Laser-induced breakdown spectroscopy (LIBS) is being used in numerous application areas, including environmental monitoring, cultural heritage, and space exploration.
Apple May Phase Out Non-Touch High-End MacBook Pros
Apple will likely consolidate its high-end MacBook Pro lineup around touchscreen models, according to Bloomberg's Mark Gurman. Writing in his latest "Power On" newsletter, Gurman questioned whether Apple would keep updating its high-end MacBook Pro models without touchscreens. The company has retained the mini-LED M5 Pro and M5 Max models alongside the new touchscreen versions, which cost $400 more.
The Quantum World Is Bursting With Chaos—Scientists Just Found What's Holding It Together
By mixing classical nudges with quantum circuits, scientists found rhythms hiding in many-body chaos that could help build better quantum computers.
Can Meta’s Business Pay For Its Spending?
For questions about this article or underlying research, email help@trefis.com.Management said on its October 21, 2026 call that Meta Platforms (META) is spending heavily on servers, data centers and network infrastructure.
EXPO-SCÈNE 2027: Save The Date For Canada’s Leading Entertainment Technology Show
EXPO-SCÈNE 2027: Save the Date for Canada’s Leading Entertainment Technology ShowApril 7–8, 2027 | Palais des congrès de Montréal
Age may influence links between psychedelic use and mental health
Age could play an important role in how psychedelic use relates to mental health, according to new research from the Department of Psychology at Durham University. Researchers found that adults with a ...
2027 South Side Sox Top Prospect No. 97: Daniel Wright
The former quarterback is finding his footing in the bullpen
Democrats sweep Pulaski County House, Senate races
With one exception, Democrats won legislative seats across Pulaski County adding two House seats and one Senate position to their column in the Arkansas legislature. Democrats held onto four of...
Democrats sweep Pulaski County House, Senate races
With one exception, Democrats won legislative seats across Pulaski County adding two House seats and one Senate position to their column in the Arkansas legislature. Democrats held onto four of...
Reps grill auditor general over Health Department oversight lapses
Less than 1% of Michigan Public Health Institute spending reached universities
Dodgers notes: Tarik Skubal, Shohei Ohtani
Free agency has officially begun, and the Dodgers are now on the clock to try to fortify their roster before the impending lockout. Left-hander Tarik Skubal is atop the list of the most highly coveted free agents this offseason, and the Dodgers are not the only bidder for his services. Jeff Passan at ESPN reports […]
'Bachelor' alum Melissa Rycroft speaks out after second DWI arrest, reveals mental health struggles: 'I need help'
HBSE names entertainment booking chief for NJ venues
HBSE appoints Joe Giordano Jr. as senior vice president of entertainment booking to oversee year-round programming at New Jersey venues including Prudential Center.
The National STEM Festival is taking its science fair global
After three years of showcasing young innovators from across the U.S., the festival is expanding internationally, with events planned for the U.K. and Mexico.
TCA Health Nutrition and Wellness Center celebrates ribbon cutting
TCA Health was recently joined by DPD Commissioner Boatright and 10th Ward Alderman Chico to celebrate the ribbon cutting for the TCA Health Nutrition and Wellness Center at 1029 E. 130th. Located in Altgeld Gardens, the center is planned by TCA Health to help address the longstanding food desert that was created when the area lost its only full-service grocery store in 2018.
Small Business Saturday campaign to begin at Mohawk Harvest After Hours
Small Business Saturday was created in 2010 to support independent merchants and redirect holiday spending locally.
Flutter Entertainment (NYSE:FLUT) reports sales below analyst estimates in Q3 2026 earnings
Global online betting company Flutter Entertainment (NASDAQ:FLUT) fell short of the market’s revenue expectations in Q3 2026 as revenue rose 2.1% year on year to $3.87 billion. Its non-GAAP loss of $0.18 per share was significantly below analysts’ consensus estimates.For more on Flutter Entertainme…
Sanford Health Column: Keeping human connection at the heart of healthcare
When used appropriately, AI documentation can make a visit feel more personal, not less. Instead of dividing attention between a patient and a computer screen, a clinician may be able to focus more fully on the conversation.
Good sleep protects brain health in people with cardiometabolic disease
People with type 2 diabetes, heart disease or stroke who sleep well have better cognitive function and greater brain volume than people with the same conditions who sleep poorly, according to a new study from Karolinska Institutet.
Police investigating 6 business burglaries on same street in Rogers Park
MSGE: Revenue rose 37% as live entertainment demand and adjusted operating income strengthened
Q1 revenue rose 37% YoY to $217.1M, with adjusted operating income reaching $34.3M. Management expects healthy live-entertainment demand and robust FY 2027 growth; quarterly share repurchases were approximately $25M.Original document: Madison Square Garden Entertainment Corp. [MSGE] SEC 8-K Current…
Ravens QB Tyler Huntley reportedly suffered season-ending turf toe injury after replacing Lamar Jackson vs. Bills
Should the Broncos trade Marvin Mims before NFL's deadline?
Marvin Mims is scheduled to become a free agent in 2027. Should the Broncos consider trading him now?
Data center memes flood X after Democrats' 2026 midterm wins
Democratic wins sparked data center memes on X, including a post from Elon Musk, as voters push for more limits on the AI infrastructure boom.
Fabian Bredlow raises suspicion about Galatasaray whistling
Speaking after VfB Stuttgart’s 2-0 defeat against Galatasaray on Matchday 4 of the 2026/27 UEFA Champions League, Fabian Bredlow expressed a suspicion regarding the whistling coming from the stands....
CVS to Split Off Pharmacy Business, Ending the Healthcare Conglomerate Era
In a breakup planned for 2028, CVS Health intends to split off its pharmacies into a new company, while keeping together its businesses in insurance and pharmacy benefits.
CVS to Split Off Pharmacy Business, Ending the Healthcare Conglomerate Era
In a breakup planned for 2028, CVS Health intends to split off its pharmacies into a new company, while keeping together its businesses in insurance and pharmacy benefits.
How space weather shapes young planets
Scientists suspect powerful solar flares helped strip away the atmospheres of planets like Mars. A Michigan State University researcher is now searching for evidence of how those same forces shape planets beyond our solar system. Adina Feinstein, assistant professor of physics and astronomy, believes exoplanets are the key to understanding the early days of our solar system. This week, she received a Schmidt Sciences FirstLight grant to investigate how space weather influences young planets.
Scientists may have finally explained why our brains and bodies are cross-wired
Scientists propose that the brain’s mysterious cross-wiring, which connects each hemisphere to the opposite side of the body, may have originated more than 500 million years ago in the visual systems of ancient fish. Rather than evolving for a specific advantage, this unusual arrangement may simply be a legacy of evolution building new brain circuits on an ancient foundation.
HCPSS Teams Up with Student Group to Drive Student Interest in and Understanding of Coding, Computer Science, and Artificial Intelligence
Several years ago, Julie Wray and Carrie Trudden, Howard County Public School System’s (HCPSS) then- and current coordinators of Instructional Technology, began receiving emails from a group called Howard County Hour of Code (HocoHOC). At the time, Wray and Trudden were unfamiliar with the group and skeptical about its offer to partner with the district […]
FMS Trainer Expands Into Business Aviation
Heading365 has signed Aviation Academy Austria as launch customer for Challenger 350/3500 FMS trainer at EATS.
Flutter Entertainment PLC: Q3 2026 Earnings Release
NEW YORK, Nov. 04, 2026 (GLOBE NEWSWIRE) -- Flutter Entertainment plc (NYSE: FLUT) (“Flutter”), the world’s leading online sports betting and iGaming...
Lobo football to health care leadership, Brad Cook finds purpose in building better systems
For Brad Cook, leadership began long before he entered the healthcare industry. As a student at The University of New Mexico, Cook received a full ride scholarship to serve as the head equipment manager for the Lobo football team. This experience gave...
CVS Health to split in two, separating pharmacy business from insurance
Nov 4 (Reuters) - CVS Health said on Wednesday it will split into two companies, separating retail pharmacy from its insurance and pharmacy-benefit operations in a major unwinding of the
CVS Health to split in two, separating pharmacy business from insurance
Nov 4 (Reuters) - CVS Health said on Wednesday it will split into two companies, separating retail pharmacy from its insurance and pharmacy-benefit operations in a major unwinding of the healthcare conglomerate it spent years building through acquisiti...
CVS Health to split in two, separating pharmacy business from insurance
Nov 4 (Reuters) - CVS Health said on Wednesday it will split into two companies, separating retail pharmacy from its insurance and pharmacy-benefit operations in a major unwinding of the healthcare conglomerate it spent years building through acquisiti...
CVS Health to split in two, separating pharmacy business from insurance
Nov 4 (Reuters) - CVS Health said on Wednesday it will split into two companies, separating retail pharmacy from its insurance and pharmacy-benefit operations in a major unwinding of the healthcare conglomerate it spent years building through acquisiti...
Breaking down the midterm results with Radford University political science professor Dr. Chapman Rackaway
Bryce Young, C.J. Stroud continue fourth seasons without new contracts
'Full-time job to keep up with it': Drug pricing program changes worry WV clinic
Beginning in 2027, Trump administration changes to the federal 340B drug pricing program will increase the purchasing and administrative costs for eligible clinics, including in West Virginia, which will have to pay up front for the drugs and seek rebates from drug manufacturers.
Wolf 1130: A Triple Star System Just 54 Light-Years Away From Earth May Go Supernova
The triple system's evolution into a "cataclysmic variable is inevitable," according to a recent paper.
Nine Xbox Games Are Releasing Today, Including A New Roguelite FPS On Xbox Game Pass (November 4)
Mech hay while the sun shines
Marc Maron is figuring out what to do with all his free time
After ending ‘WTF With Marc Maron,’ the comedian is embracing privacy, pursuing new projects and figuring out life beyond the microphone.
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 […]
Letters: Science isn’t scary, it’s educational | Book-ban hypocrisy
Science is wonder; evolution isn’t scary Regarding the claim that the state education plan is de-emphasizing evolution (“Florida education chief defends science plan as critics say it ‘danced around’ evolution,” Oct. 28): Science is won…
Berks Nature to Launch New Mental Health Effort
During the 18th annual State of the Environment Breakfast, Berks Nature will introduce the first tool in what the nonprofit envisions as a multidisciplinary community partnership to help local youth find peace, healing, and connection in nature: a map of Reading’s 50+ parks, playgrounds, and green spaces.
Three Trade Partners for the Detroit Tigers This Winter
With the team needing relief pitching and several teams needing outfield help, the Detroit Tigers have several potential trade partners. The Motown team allowed 11 walk-off hits in 2026 and blew 32 saves, both the most by an American League team. Although their offensive core and deep starting rotation will be back for next season, …
Good sleep linked to better brain health in cardiometabolic disease
People with type 2 diabetes, heart disease or stroke who sleep well have better cognitive function and greater brain volume than people with the same conditions who sleep poorly, according to a new study ...
Emperor Entertainment Hotel Expects Profit Attributable Of Not More Than HK$35 Million For HY
Emperor Entertainment Hotel Limited HKEX:296:
‘Enraging’: WA residents despair as insurance premiums climb again
SEATTLE — Kate Neville is dreading the new year. As a freelance grant writer, Neville has to buy her own health insurance, and for years her premiums have been climbing.
No catastrophic financial hit required to fight climate change, scientists say in landmark court case
Canada does not need to shut down its industries or take a catastrophic financial hit to effectively fight climate change, one of the country's leading climate scientists testified during a landmark trial in a Vancouver courtroom this week.
Manatee farm develops patent-pending new strain of grass
Bayside Sod is diversifying, developing a new type of grass and offering turf care service.
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 ...
Silicon Valley‘s political spending spree meets a blue wave — and a data center revolt
Tech billionaires poured hundreds of millions into the midterms, but it didn’t buy them much.
Star Health's Arogya Seva Kendra clinics cross 1.8+ lakh beneficiary visits within a year of their inception, bringing free primary healthcare to communities across 9 states
Star Health and Allied Insurance Company Limited (NSE: STARHEALTH) (BSE: 543412), India's leading standalone health insurer, has been safeguarding the health and well-being of millions of Indians for over 20 years through a strong focus on customer-centricity, transparency, and innovation. Reflecting its commitment to creating lasting social impact, Star Health's CSR initiatives focus on improving health outcomes through accessible healthcare, preventive interventions, and community wellness pro
Jets Make NHL History With Stunning Comeback Win Against Habs
The Winnipeg Jets appeared destined for what would have been a 10th straight loss, finding themselves trailing by a 4-0 score against the Montreal Canadiens at Bell Centre on Tuesday night.But then, suddenly, everything clicked and resulted in a stunning and historic turnaround, not only ending their miserable losing skid but also setting a new […] The post Jets Make NHL History With Stunning Comeback Win Against Habs appeared first on HEAVY.
Democrat Abdul El-Sayed projected to win Michigan and become nation’s first Muslim senator
Meghan Markle ‘Doomed To Be a Hate-Watch’ on MasterChef Australia
Meghan Markle’s MasterChef Australia gig might grab attention for the wrong reasons. According to a source, the Duchess of Sussex’s appearance in next year’s Junior MasterChef could steal the spotligh...
G5 Entertainment: Established-game declines weighed on revenue as G5 Store growth lifted margins
Revenue fell 20% YoY as established games weakened, while gross margin hit 74.1% and adjusted EBIT rose YoY. G5 Store distribution, cost savings and a soft-launched new game are key growth levers, with new-game scalability still uncertain.Based on G5 Entertainment AB [G5EN] Q3 2026 Audio Transcript…
Democrats seize power in Texas, ending decades of GOP dominance
Texas’ governor, lieutenant governor, attorney general and every other statewide candidate fell, upending the state’s political power structure in one night.
Pacific Scientists Build a Regional Picture of a Changing Ocean
Understanding how ocean acidification is unfolding across the Pacific requires more than individual research projects or monitoring stations.
Nebraska voters appear to say 'no' to legalizing online sports betting
Though margins were still slim late Tuesday night, Nebraska voters were on track to reject a pair of ballot measures looking to legalize and regulate online sports betting, according to unofficial results. Initiative Measures 440 and 441 would together amend the Nebraska Constitution and state law, respectively, to legalize and regulate online sports wagers. Initiative […]
Lewiston’s mayor faces runoff after a tumultuous year in city politics
Challenger Rick LaChapelle had 45.7% of votes to 35.3% for Mayor Carl Sheline, according to unofficial results.
Democrats win control of the U.S. House
Democrats win the U.S. House and take unified control of Congress as voters deliver resounding rebuke to Trump.
Flats plan for aparthotel in Reading after business changes
City Wall House's apartments are used less following the pandemic, the building's owner says.
Tight race between LA Mayor Karen Bass and democratic socialist Nithya Raman
The first returns were a tally of mail ballots received before Election Day. Others, including results from in-person voting, were to follow.
Tight race between LA Mayor Karen Bass and democratic socialist Nithya Raman
The first returns were a tally of mail ballots received before Election Day. Others, including results from in-person voting, were to follow.
St. Albert the Great Academy: Finding amazement in agrarian science
St. Albert the Great is typically remembered in history by his Latin title, "Albertus Magnus." This Dominican abbot and bishop in the Catholic Church is remembered not just for his
Washington initiative to ban trans students from girls’ sports ahead in early returns
A statewide ban on transgender students competing in girls’ school sports was leading on election night, according to early tallies.
Cold showers: A rewarding way to cut your emissions?
Making this small change to your daily routine could be as impactful as recycling.
Problems at health trust buildings could cost additional £20m
The maternity building on the Royal Victoria Hospital site is already tens of millions of pounds over budget.
The historic firsts of the 2026 election
Winners up and down the 2026 ballot will make history this year, CNN’s Decision Desk projects, including the first Black woman governor and the first out gay male US senator.
Democrats flip four governorships, extending the party’s inroads into red states
Republicans entered Tuesday’s midterms with a 26-24 advantage in governor’s offices across the country.
Trump says Democrats 'did a good job,' blames Republican candidates for midterm losses
Voters delivered a significant rebuke to President Donald Trump on Tuesday by handing Democrats control of the Senate, rejecting his handpicked candidates while airing widespread concerns about high costs in the wake of his war against Iran and his punishing tariff policy.
SC secretary of state wins 7th term leading office for business filings
South Carolina’s longtime secretary of state, Mark Hammond, won a seventh term in office.
Iconic country music act cancels LA show just hours before showtime: 'Flew in from Oklahoma for this!'
US stock futures mixed as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
US stock futures tumble as Democrats score key midterm election wins
Wall Street faces fresh uncertainty over what Democratic control of Congress could mean for taxes, government spending and regulation.
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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