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OU Health NICU babies celebrate Halloween as 101 Dalmatians
Oklahoma Children’s OU Health NICU babies dressed as 101 Dalmatians for a Halloween celebration organized by their care team.
Delivering deliciousness: DONOS Mini Donuts is a dream turned into reality
After years of offering business advice to others, John-Michael Marlin is turning a dream to reality by opening DONOS Mini Donuts.
Snowfall and clouds may slow East Antarctic ice loss in a warmer world
A new modeling study, published in the journal Nature Climate Change, suggests that the East Antarctic Ice Sheet may be more resilient to extreme long-term warming than previously estimated. Increased snowfall, greater cloud cover, and changes in atmospheric circulation could partially offset ice loss—even under very high carbon dioxide concentrations. Researchers from the IBS Center for Climate Physics at Pusan National University in South Korea conducted idealized simulations with different atmospheric CO2 levels, spanning 100,000 years using a coupled global climate–ice-sheet model. Unlike conventional studies that prescribe atmospheric and oceanic conditions, the model allowed climate and the Greenland and Antarctic ice sheets to evolve together.
Juliana Stratton makes history with Black women in the Senate
Democrat Juliana Stratton won election Tuesday to the U.S. Senate representing Illinois, defeating Republican Don Tracy. Currently lieutenant governor, Stratton will succeed Sen. Dick Durbin, a Democrat who is retiring after five terms. Stand with free and independent journalism. Join Press Pass from PBS News Stratton will be the second Black woman to serve Illinois in the Senate. She was twice elected lieutenant governor as Gov. JB Pritzker’s running mate and had Pritzker’s endorsement in
Debra Lienhardt Honored by New Jersey Legal Awards as In-House Impact Winner
Debra Lienhardt, RWJBarnabas Health Executive Vice President, Chief Business Development and Legal Officer, has been named by American Lawyer Media’s New Jersey Law Journal the recipient of the In-House Impact award from the New Jersey Legal Awards, which celebrate the trailblazers, innovators, and dedicated professionals who have made a lasting impact on both their organization’s and the State’s legal landscape.
Vantage Launches Facultative Reinsurance Business, Names Pickard as President
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Can AI save global health or will it deepen inequities?
Can artificial intelligence compensate for billions of dollars in disappearing global health funding? Learn what journalists should ask.
Local business confidence concerns have eased compared with 2025, index shows
Southern Nevada business leaders are still feeling uncertain about the economy’s future, but fears have eased when it comes to hiring, sales and profits, according to a new report.
Fresno SEDA plan could generate $2.5 billion surplus, study finds
A new study projects Fresno's SEDA plan could generate a $2.5 billion surplus over 15 years, as supporters and opponents debate the proposed expansion.
Fresno Fair consumer testing helps local food businesses
Discover how F3 Local gathered 342 consumer responses at the Big Fresno Fair to help Central Valley food entrepreneurs improve products and packaging.
How to watch Oregon State men's, women's basketball in 2026-27
Here's how to watch the Oregon State Beavers men's and women's basketball teams during the 2026-27 NCAA season.
‘Chest Candy’: Award-winning Short Film Featured At Veterans Mental Health Conference
To help understand the struggles, multi-award-winning actor and filmmaker Robert X. Golphin brings “Chest Candy,” his award-winning short drama to Huntsville
Black voter turnout appears high on Election Day, according to voter coalition
LaTosha Brown, co-founder of the voting rights group Black Voters Matter, said turnout in some states seemed to rival that of 2008, when Democrat Barack Obama was running for president for the first time. Stand with free and independent journalism. Join Press Pass from PBS News She and others said turnout appeared particularly high in Michigan and Mississippi. Brown, speaking during a media briefing organized by the National Coalition on Black Civic Participation, said her
Faraday Future Makes a Shift
Spinning off its robotics arm to an independent division, physical artificial intelligence company Faraday Future Intelligent Electric Inc. has turned its
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
Guest columnist: Science of finding cancer early just proved itself
Residents of Houston’s Fifth Ward live adjacent to documented creosote contamination. The neighborhood is 94% non-Hispanic Black. It is a state-designated cancer cluster. Those who live there do not need […]
Darren Paltrowitz brings entertainment experience to Hewlett-Woodmere Public Library
Long Beach resident Darren Paltrowitz is using his entertainment journalism and podcasting experience to develop creative programming for young adults at the Hewlett-Woodmere Public Library, connecting local communities with new ideas, cultural experiences and unexpected topics.
For Iowa Journalist Laura Belin, Covering Politics Is a Constant Battle
Laura Belin is an openly liberal journalist in Iowa who has long been shut out by state Republican officials. Now she’s being bypassed by Democrats who favor friendly internet influencers.
Townhome developments planned on Laurens, Anderson roads in Greenville
Two proposed townhome developments were presented during the city of Greenville’s project preview meeting Oct. 27.
Analysis: Catholic Memorial hangs on to beat New Berlin West
Journal Sentinel sports reporter Michael Whitlow breaks down Catholic Memorial's victory over New Berlin West on Friday, Oct. 30, in New Berlin.
Siri AI Gets More Capable in iOS 27.3
Apple is expanding what Siri AI can do in and across apps in iOS 27.3, which is available to developers as of today. Siri can complete tasks across Calendar, Files, Finder, Journal, Mail, Maps, Messages, Music, Notes, Photos, Preview, Reminders, Safari, Shortcuts, and Weather. You can ask Siri AI what you can do with each app to get more information on what's possible. In Mail, for example, Siri can unsubscribe you from mailing lists and undo recently sent messages.
Smith/Patterson Science Journalism Lecture hosts CNN journalist
The Missouri School of Journalism partnered with the Pulitzer Center for this semester’s Smith/Patterson Science Journalism Lecture on Oct. 26. The lecture, “Growing Pressure on Cancer Care and Research,”featured CNN science journalist Caleb Hellerman. Hellerman has been reporting on cancer care and research in a long-running series with CNN for the past year. The main...
People on the Move: Adventist Health expands, FOX26 adds anchor
WritingCentral Valley People on the Move: Adventist Health adds providers, FOX26 welcomes a new anchor, and local professionals earn honors across industries.
Judge dismisses Trump suit against Wall Street Journal over Epstein birthday letter
U.S. District Judge Darrin Gayles in Miami dismissed the suit with prejudice, ruling that the president did not prove the defendants made defamatory statements with actual malice as required by law.
Cognitive Health Technologies Data Breach Affects 49,500 Individuals
Data breaches have been announced by Cognitive Health Technologies in New York, City Ambulance Service in Texas, Baraga County Memorial Hospital in Data breaches have been announced by Cognitive Health Technologies in New York, City Ambulance Service in Texas, Baraga County Memorial Hospital in Michigan, The Speech Clinic in Georgia, and Innovative Alternatives in Texas.
How Huntsville Small Businesses Can Partner With NASA To Land Humans On The Moon In 2028
In 2027, NASA plans to send four astronauts aboard its Orion spacecraft on a 14-day mission in low Earth orbit to test systems needed to return humans to the
Trump Takes Shot at Reporter’s Weight After Question About His Own Health: ‘You Look Like Hell’
Donald Trump took aim at reporter Jacob Bogage's weight after the Reuters journalist asked a question about the president's own health.
Survivor Sweat marketplace offers Circa contestants life after elimination
Survivor Sweat is an online marketplace where participants in Circa football contests can list all or a portion of their entries for sale, and where buyers can purchase them.
Meta delays new business terms after outcry over potential web scraping of news sites
Meta is delaying new terms for business accounts after a backlash from media companies and open-web advocates. The terms, set for October 30, would allow Meta to use automated tools to scrape data from business accounts. Critics argue this could lead to Meta building competing services using the scraped content. A Norwegian court recently suspended the terms, and the UK is investigating. Meta insists the terms are about accurate product information, not news scraping. Despite Meta removing the word "train" from the terms, European critics remain unsatisfied, emphasizing the impact on journalism and media diversity.
Cloud Firm Lands $100M Series A
General Compute Inc., a Covina-based neocloud startup, announced on Tuesday that it raised $100 million in series A funding. The round was co-led by
Lansing History: Third-generation baker brings the family business — Calumet Bakery — to Lansing
The original Calumet Bakery was located on 106th Street just east of Bensley Avenue in the South Deering neighborhood of Chicago. It arrived in Lansing by the third generation —
The Daily Mauling: 11/2/26
Kansas Jayhawks News The Lawrence Journal-World wrote about what we learned in KU’s loss to TCU KU hoops will play their first regular season game of 2026-27 against Fordham tonight Kansas Volleyball swept K-State in front of a record setting crowd Friday night Links! Haley Stevens, a democrat who lost her primary for the senate […]
Maine health clinics urge state for cost-of-living increase, predicting loss of services without it
Clinics say they are struggling without the $6.5M adjustment.
Tips for covering this year’s flu season
Flu can be a serious, even deadly illness for older adults. People over 60 make up less than 20% of…
City Enacts Changes to Cut Public Filming Costs
As city and state officials scramble to slow down film and TV productions’ flight out of Hollywood, the L.A. City Council passed two measures last week
Longtime journalist and ESPN commentator Michael Wilbon is taking a leave of absence
Wilbon, who turns 68 later this month, said he is taking a trip to “the injured list” but added he hopes it is “not an extended one.”
Watch: Mark Banks intercepts a pass for Whitefish Bay
Whitefish Bay's Mark Banks intercepts a pass against Wisconsin Lutheran on Friday, Oct. 30, in Whitefish Bay.
Vote! Who should be Maps Credit Union boys Athlete of the Week?
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Office Visit: A prescription for peace of mind
Todd Hoffman explains how health insurance supports preventive care and why Oklahomans should review coverage during open enrollment.
Leadership Berkeley graduates 27 business and community leaders
MARTINSBURG — Twenty-seven business and community leaders celebrated their graduation from the Martinsburg-Berkeley County Chamber of Commerce’s Leadership Berkeley Program during an Oct. 29 ceremony at The Sycamore.
Business Strategy: Shopping local is an investment in Oklahoma City’s future
Kenton Tsoodle highlights local retailers’ economic impact and urges Oklahoma City residents to shop small this holiday season.
California Prop. 44 would require clinics to spend 90% on patient care
California Proposition 44 would require community clinics to spend 90% of revenue on patient care. Here's what supporters and opponents say.
Latest World & National News & Headlines
USA TODAY delivers current national and local news, sports, entertainment, finance, technology, and more through award-winning journalism, photos, and videos.
Sam Royka discusses Tulsa engineer’s adaptive fitness tech on KFOR
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Health insurance for freelancers: What to know for 2027
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Kerrigan in the DC Journal: America's Innovation Economy Runs on Small Business - Why Protecting Bayh-Dole Matters - Small Business & Entrepreneurship Council
In an Op-Ed published in the DC Journal this week and now appearing in local newspapers across the country, SBE Council President & CEO Karen Kerrigan highlights the indispensable role of small businesses and startups in driving American innovation, technological advancement, and economic growth. Kerrigan points to the extraordinary success of the bipartisan Bayh-Dole Act, […]
Central Valley golf cart business lands among nation's top 10 small businesses
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Milwaukee Brewers World Series win highlight of baseball life
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Nearly half of US adults under 65 had little to no health insurance in 2026: Report
Nearly half of U.S. adults had inadequate health insurance in 2026, as ACA marketplace enrollment declined and millions lost Medicaid coverage.
Kentucky women's basketball breezes past Morehead State in season opener
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The real problem with Britain’s Political Traitors show is that no one is very faithful to anything for long
For Westminster’s special budget edition of the series, politicians have played to their strengths. Bombast, duplicity, distrust: it’s all second nature, says journalist and author Robert Hutton
New interns are covering science and environment, politics and sports
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CanopyNation expands employee benefits solutions after combining with ICG
MEMPHIS - Memphis-based insurance and employee benefits firm CanopyNation has combined operations with Insurance Consulting Group Inc., a leading Memphis employee benefits agency.
Grab the popcorn; it’s political
During election season, political debates and campaign ads are seemingly everywhere, and it can be hard to escape politics. But for those looking to explore politics beyond the headlines, movies can offer a different way to look at elections, journalism, government and political power. From investigative journalists uncovering scandals to fictional politicians navigating campaigns, these...
Health of Wisconsin S Marvin Burks, DL Nolan Vils continues to improve
The Big Ten released its second update to the availablity report in advance of the Wisconsin-Iowa football game Oct. 31 at Kinnick Stadium.
Gateways Starts Upgrades
Mental healthcare in Los Angeles County has long lagged behind the tremendous demand across all levels of care. Now, one of L.A.’s oldest mental
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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