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More Than 1,000 Gather at Booth–Kellogg ETA Conference to Explore Buying and Building Businesses - Polsky Center for Entrepreneurship and Innovation
More than 1,000 people attended the 13th Annual Booth–Kellogg Entrepreneurship Through Acquisition (ETA) Conference last week, bringing together entrepreneurs, investors, MBA students, and faculty from around the world to explore what it takes to find, acquire, and grow a business. Hosted by the Polsky Center for Entrepreneurship and Innovation, the ETA Group at Chicago Booth,
Selling Your Company: When Every Stroke Counts
JEROME FOGEL Partner, Corporate Practice Group; Chair, Sports and Entertainment Group Fogel & Potamianos LLP For owners of successful middle-market
Julia Posen announced as Managing Director of The Path Entertainment Group
The Path Entertainment Group have today announced that Julia Posen will be stepping into the role of Managing Director. The global live entertainment and experiential production company specialises in large-scale, IP-driven interactive experiences and theatrical productions.
Business Owners Have a Window. Most Aren't Ready to Use It. by Tully Ryan
I spend my working life on both sides of a business sale. As an M&A advisor based in Wilmington, I help lower middle market owners across North Carolina, South Carolina and Virginia sell what they've built. As the founder and CEO of IQExit, I work with the bankers, wealth advisors, CPAs and attorneys who sit beside those owners for years before a sale ever comes up. From both seats, I keep seeing the same thing. The market is ready for our owners. Too many of our owners aren't ready for the market. Start with our own backyard. Wilmington's metro area added more than 12,000 residents between July 2024 and July 2025, a 2.6% jump that ranked seventh in the country. It also posted the highest job growth rate of any metro in North Carolina. I see the same pattern in the growth markets I work in across the Southeast. New residents mean new customers and new workers. They also mean new buyers: people who moved here from corporate jobs and want to own something, private equity groups looking for add-ons in HVAC, electrical, landscaping and other trade services, and younger entrepreneurs who would rather buy a running business than start one from scratch. The ownership numbers are hard to ignore. About half of North Carolina's small businesses have an owner who is 55 or older, and roughly 85% of those owners have no succession plan, according to the North Carolina Employee Ownership Center. Nationally, more than half of Baby Boomer business owners have no documented transition plan. That isn't a crisis yet. It's a timing problem. A lot of businesses will change hands over the next decade, and the prepared ones will get the better buyers and the better terms. Buyers have money and they're using it. But an active market doesn't mean a fast one. The IBBA's latest Market Pulse survey found that Main Street deals took six to 10 months from engagement to close in the second quarter, and lower middle market deals took 11 to 12 months. That clock starts after the owner decides to sell. In my experience, the real preparation has to start years before. Two clocks, two playbooks When I sit down with an owner or their advisor, my first question isn't “What's it worth?” It's “When?” The answer puts the owner in one of two groups. If the owner wants out within 24 months, we're in execution mode. There's no time to rebuild the business. The work is cleaning up what a buyer will test: three years of financials that tie to the tax returns, an add-back schedule you can prove, customer and vendor contracts in writing, a lease that can be assigned, and a price the market will actually pay. The goal is certainty to close. If the exit is two to five years away, the owner has something worth more than time. They have choices. That window is where most value gets built, and most owners waste it by waiting. What kills deals In the lower middle market, deals rarely die over the headline price. They die in diligence, or they get retraded late in the process. I see the same causes again and again. The owner is the business. If every key customer relationship runs through the owner's cell phone, a buyer sees risk and a lender sees more of it. The books don't hold up. Buyers spot weak accounting fast. Statements that get revised mid-process, a revolving door in the bookkeeper's chair, revenue tracked on a side spreadsheet, and margins that slip while sales climb with no clear reason all make a buyer nervous. So does an owner who pushes back when asked for documents. And plenty of private owners run personal expenses through the company. Add-backs are normal. Add-backs you can't document turn into a lower offer. The real estate isn't sorted out. Many owners hold their building in a separate LLC. That's fine, but the lease terms or the property sale should be settled before a buyer shows up, not halfway through diligence. Revenue sits in too few hands. Picture a contractor with 40% of its work coming from one builder, or a service company running on handshake deals. Buyers will still look, but the terms shift toward more seller financing, an earnout, or less cash at closing. Owners and advisors: if your exit is three to five years out • Get a baseline now. Find out where the business really stands today: what a buyer would pay, who that buyer is likely to be, and which gaps would hurt you in diligence. You can't fix what you haven't measured, and the answer is often different from what the owner expects. • Make yourself less necessary. Spend the next few years building a manager or small team that can run daily operations and own customer relationships. Put handshake deals into written contracts. A business that runs without its owner is worth more and is far easier to finance. • Clean the books for three straight years. Buyers and lenders look back at least three years. Separate personal expenses, keep the financials tied to the tax returns, track every add-back as you go, and settle the real estate plan early. A word to CPAs CPAs often see a sale coming before anyone else, and you're usually the most trusted voice an owner has. Year-end meetings are the right time to start this conversation. Here's what I'd ask every CPA to do this season with business owner clients over 55: • Ask the timing question. “Do you see yourself owning this business in five years? If not, who takes it over?” Write down the answer and bring it up again at next year's meeting. • Run a proof of cash and review revenue recognition. Make sure the cash in the bank ties to the revenue on the books. Pay close attention to contractors with work in progress and to companies selling memberships or service plans. These issues are easy to fix with years of lead time and painful to fix a month before closing. • Pair the tax return with an exit readiness review. Invite clients to complete IQExit's Exit Readiness Intelligence (ERI) process as part of year-end planning. It gives you and the client a shared picture of readiness gaps and an indicative value range, and the results come back to you as the advisor. That turns a tax meeting into a planning relationship, and it puts you in position to bring in tax and M&A help early, when choices like purchase price allocation can still save the client real money. Changing the conversation For bankers, wealth advisors and attorneys, the hard part is raising the subject without seeming to nudge a client toward the door. I understand that. Nobody wants to tell a 60-year-old owner it's time to sell. So don't. Ask a different question: “If a buyer called tomorrow, what would they find?” That's a planning question, not a pitch, and it's useful whether the exit is two years out or 15. It's the question we built IQExit to help advisors answer. Whether you're in Wilmington, Raleigh, Charleston, Richmond or anywhere else, owners have a real opening right now. The buyers are out there and so is the capital. The owners who come out ahead will be the ones who start getting ready before they're ready to sell.
Health players backed Raul Ruiz’s campaign
Ruiz enjoyed more support from health trade organizations and industry groups than Castor, showcasing his existing relationships with the healthcare industry.
Scor’s profit slips 6%
France-based Scor SE’s net income for the first nine months of 2026 fell 6% year on year to 603 million euros ($673 million), Reinsurance News reported. Group insurance revenue dropped 4% to €11.2…
Iowa governor candidates address political agendas in schools
Two Polk County advocacy groups have the same concern: political ideology in the classroom. Moms for Liberty and Annie’s Foundation stand on opposing sides of the debate over what should be allowed in schools and both organizations said they believe the situation has worsened over the years. Jennifer Turner, mom and chair for Polk County’s...
Duly’s private equity backer looks for an exit: report
Ares Management is seeking a buyer for its stake in Illinois’ largest independent physician group after almost a decade.
Crowd Gathers at Legacy MD Fall Health Fair
Legacy MD Medical Group’s parking lot was packed with guests, activity booths and informational booths during their annual Fall Health Fair on Wednesday, Oct. 28.
Baptist Health expands pediatric services in Jacksonville
The not-for-profit hospital group acquired two Privia Medical Group clinics.
Julia Posen Announced As Managing Director Of The Path Entertainment Group
A press release marked under embargo was received but content details were not disclosed. The Path Entertainment Group has announced that Julia Posen will…
Is CVS Health Stock Worth More Than Its Competitors?
For questions about this article or underlying research, email help@trefis.com. In a peer group with UnitedHealth Group, Cigna and Walmart, CVS Health (CVS) ranks second of four on revenue growth and third on operating margin. CVS shares trade at 23.6 times earnings, compared with 12.
AIG beats profit estimates on premium growth, investment income
American International Group swept past analysts’ estimates for third-quarter profit on Tuesday, as higher investment income and premium growth helped offset a jump in catastrophe losses.
Deloitte Forms US Oracle Business Group to Power End-to-End Enterprise Transformation
Deloitte today announced an expansion of its alliance with Oracle with the formation of the Deloitte Oracle business group, bringing together Deloitte's Oracle-focused capabilities across AI, applications, cloud infrastructure, data, cyber and managed services. The new group is designed to help clients modernize their Oracle environments, explore and scale agentic AI deployments — and draw on Deloitte's AI-infused service delivery platform Ascend™ and Deloitte Forward Deployed Engineering (FDE)
Thousands of Georgians face health care premium sticker shock during open enrollment
State data shows health insurance premiums have jumped between 15% and nearly 29%, according to Liz Coyle of the consumer advocacy group Georgia Watch.
Power Players: Innovators in Women’s Sports — Laura Correnti, Deep Blue Sports + Entertainment
Power Players: Innovators in Women’s Sports — Laura Correnti, Deep Blue Sports + Entertainment
COL Group takes vertical entertainment to new heights with FlareFlow's Thailand debut
FlareFlow makes its Thai debut on AIS PLAY with English, Chinese and Korean titles, all localised with Thai subtitles for a wider audience.
Opinion: Faith groups need to speak to this political moment
It’s time that faith groups put politics back on the table, even on the communion table.
Group of artists growing in member numbers, services
Fall has arrived, and Citrus Watercolor Society member palettes and brushes are already in full use. And the fun continues through October and November.
This year, everyone is going low: Political groups spend 3 times more on negative ads than positive
If you feel like you saw an inordinate amount of negative political ads on your phone or TV the past few weeks, you’re right: Of the $47 million that outside groups have spent on the general election as of Oct. 19, the vast majority has gone to ads attacking opposing candidates rather than touting preferred […]
Houlihan Lokey Expands European Business Services Capabilities With Senior Hire
LONDON, November 02, 2026--Houlihan Lokey, Inc. (NYSE:HLI), the global investment bank, announced today that Adnan Choudhury has joined the firm as a Managing Director in its Business Services Group. Based in London, Mr. Choudhury will focus his coverage on professional services across Europe, further strengthening the group’s sector expertise and client reach across the region.
RIIZE turns to literature to deepen story behind 'Insomnia'
K-pop group RIIZE is turning to literature to tell a deeper story, pairing its new single "Insomnia" with fiction and illustration in an experiment...
Luka Doncic Posts Historic Statline to Lift Lakers Over Raptors
With the Los Angeles Lakers in need of a bounce-back win after falling to the Golden State Warriors to open the Emirates NBA Cup group play stage, superstar Luka Doncic set the tone defensively and filled up the stat sheet Sunday night. Welcoming in the Toronto Raptors two nights after a 112-95 road loss to …
Baystate Mercy Hospital officially joins Baystate Health system
Baystate Health has integrated Baystate Mercy Hospital and 45 regional medical group entities into its health system while launching a new electronic health record system across its network.
Table tennis group helps black men tackle mental health
Participants say the sessions create friendships and conversations they struggle to have elsewhere.
Exclusive: Dana Maiman is leaving Omnicom Health. Tom Schwenger will succeed her
Maiman oversaw the group following the holding company’s acquisition of IPG.
Who is TWS? The group answers in heartfelt letters sent to fans and 'To Us.'
The six-member Pledis boy band reflects on its growth, fan bond and ambitions for bigger stages through its new single album.
Sopra Steria Completes Acquisition of the Manufacturing Engineering Business From Daher Industrial Services a Group Daher Subsidiary
PARIS, November 02, 2026--Regulatory News: Sopra Steria (Euronext Paris: SOP), a major tech player in Europe, has announced that it has completed its acquisition of the Manufacturing Engineering business from Daher Industrial Services to bolster its expertise in aerospace engineering.
After topping 2024’s donor list, Elon Musk said he’d do ‘a lot less.’ Since then, he’s given more than George Soros has personally in his lifetime
Musk has given $427 million to federal political groups since May 2025. Soros has given $243 million of his own money since 1979.
Tony Butala, co-founder of Lettermen vocal group known for ‘The Way You Look Tonight,’ dies at 87
Tony Butala, co-founder of the Grammy-nominated trio The Lettermen, has died at age 87.
KARA Want a World Tour and New Music for Their 20th Anniversary
The iconic K-pop girl group shared their hopes for their milestone anniversary during a recent fan-con event in Japan.
Enstar promotes Ni, hires Jones and Chai for executive roles
Enstar Group said Friday it has promoted David Ni to president and hired former Chubb executive Mike Jones as chief operating officer and former Zurich North America risk leader Ann Chai as chief risk…
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.
Black Sports Professionals expands executive accelerator to develop next generation of sports leaders
The National Society of Black Sports Professionals launched its third Sports Business Executive Accelerator to continue to advance inclusion in sports business.
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Justice Department urges sanctions for database analysis critical of its noncitizen voting claims
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REG - Science Group PLC
RNS Number : 2733B Science Group PLC 02 November 2026 2 November 2026Science Group plc(the "Company" or "Science Group")Change to buyback reportingScience Group plc (AIM:SAG) announces that, with effect from 2 November 2026 and in line with changes to the AIM Rules, the Company will change the…
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Tony Butala, co-founder of Lettermen vocal group known for 'The Way You Look Tonight,' dies at 87
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Unaffiliated voters are the fastest-growing group in Pennsylvania. They can decide who controls Congress.
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Tony Butala, co-founder of Lettermen vocal group known for 'The Way You Look Tonight,' dies at 87
Tony Butala, co-founder of the Grammy-nominated trio The Lettermen, has died at age 87 | Talk 1370
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Power Players: Innovators in Women’s Sports — Dr. Kate Ackerman, Women’s Health, Sports and Performance Institute
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Who's enforcing the rules on billions in political spending?
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AIG agrees to buy Everest’s Chile business
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SHRO One Health Research Group Strengthens Its International Scientific Network and Advances Environmental Sentinel Research at Ramazzini Days 2026
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Podiatrist Juan E. Sardiña, DPM, Joins Palm Beach Health Network Physician Group - Florida Hospital News and Healthcare Report
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Groups urge WHO to review ‘outdated’ drinking water standards
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Japanese online service company GMO apologizes for security breaches and promises compensation
Japanese online service company GMO Internet Group has apologized for security breaches from cyberattacks, and promised to prevent a recurrence and compensate victims.
X-Ray Timing Science Analysis Group (XR Timing SAG)
X-Ray Timing Science Analysis Group (XR Timing SAG)
Janeese Lewis George is Washington's next mayor. Now come the challenges, starting with Trump
Janeese Lewis George joins a small group of democratic socialist municipal leaders.
Progressive political groups sue Alaska elections officials for failing to open rural voting sites before Election Day
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