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Morgridge Institute co-founder brought a public service vision to Wisconsin science
Tashia Morgridge, co-founder of the Morgridge Institute for Research and philanthropist devoted to education and public engagement across Wisconsin, passed away last week at age 93.
New York state reports 1st measles-associated death in over 30 years
A child died in Lewis County associated with the ongoing measles outbreak, health officials said.
3 things I learned about caring for my mother with Alzheimer's
Karen Finocchio, whose mother showed signs of Alzheimer's at 54, reflects on the positive things she did and those she wish she'd done differently.
The Last Disney+ Original?
(Welcome to my weekly streaming ratings report, the single best guide to what’s popular in streaming TV and what isn’t. I’m the Entertainment Strategy Guy, a former streaming executive who now analyzes business strategy in the entertainment industry. If you were forwarded this email, please subscribe to get these insights each week.) Before we get going, I wanted to remind readers about how I plan to keep your trust while I add advertising to this newsletter. As you’ve no doubt noticed, I’m running ads now, but the danger is that it could impact my analysis and writing. I have a list of sponsors on my About Page, so if you think I’m biased, you can check out who’s sponsored this newsletter! This is something that I’m not sure anyone else in digital media does (if you’re a writer or media outlet and you do this, let me know and I’ll shout you out!) but it’s something I’d love to see embraced by the entire industry. Sunlight, i.e. transparency, is often the best disinfectant. Okay, on to this week’s issue. We (finally) have another major Disney+ TV show to talk about, so that’s my main focus for today. Plus, we had a lot of new shows come out, including the fourth seasons of The Diplomat and Tulsa King! And Love is Blind! The Lowdown! Also, four (four!) straight-to-streaming films came out this week, featuring a lot of big names and celebrities, so I’m going to look at those. All that, mixed news for the WNBA, Reacher ends its run on the charts, Skydance does well in September viewership, NYU’s Sundance dominance, all the flops, bombs and misses, and a whole lot more. Let’s dive right in! (Reminder: The streaming ratings report focuses on the U.S. market and compiles data from Nielsen’s weekly top ten viewership ranks, Luminate’s Top Ten Data, JustWatch and Reelgood interest data, Samba TV household viewership, company datecdotes, Netflix hours viewed data, Google Trends, and IMDb to determine the most popular content. While most data points are current, Nielsen’s data covers the weeks of October 12th to October 18th, 2026. You can find a link to my terminology here.) Subscribe Television - Disney+’s Porridge Problem Listen, per my headline, VisionQuest isn’t the last Disney+ Original. At least, I’m pretty sure it’s not. They have other MCU shows in development. Well, maybe one: But it sure feels like the end of an era. I’d call it their “porridge too hot” era, to quote myself from The Ringer. I told Ben Lindbergh that Disney+ seemingly couldn’t figure out the right amount of content. In the heights of the Streaming Bubble Era (circa 2019 to 2022), they started releasing an insane amount of TV shows. After their growth slowed, they’re down to two or three shows a year, and that might be down to 1 by 2027. Here’s my TV shows by year chart: Even at the time, I thought Disney was making too many shows (that cost too much). Today? They’re definitely making too few shows (though the budgets are more in check, at least according to the reporting). Porridge too hot, porridge too cold; too many shows, now not enough. Which makes evaluating VisionQuest so interesting. This show didn’t have a great lead-in, whether it be a Marvel Cinematic Universe film (the last non-Sony-produced-Spider-Man flick came out The Fantastic Four from July of 2025) or Marvel Cinematic Universe TV show (the two this year were Wonder Man back in January and _Daredevil: Born Again_in May, both of which underwhelmed). And so far, VisionQuest hasn’t quite recaptured the MCU Originals glory, but it has some signs of sparks. First, it made Samba TV, though at a lowly ninth place. At least it made it, a feat some other Marvel shows didn’t accomplish. (Ironheart landed on the Samba TV charts one week at tenth place, but Wonder Man and Daredevil: Born Again both missed.) VisionQuest also made Luminate, though with only 3.0 and 7.6 million hours. But it missed Nielsen in its first week. The best news might be its 7.8 on IMDb, on 12K reviews so far, great numbers, even for a superhero show. Looking at those numbers, this show will really need to pick up in future weeks—and it may since it’s coming out weekly—or Disney will have another disappointment on its hands. Disney+ binge-released their last few shows to try to boost numbers, but that meant shows like Iron Heart and Wonder Man didn’t last long on the charts. _Daredevil: Born Again’s_last season missed entirely (though it came out weekly). Here’s the Disney+ Originals by totals: And for a fun new look, here are those same shows, rearranged by the years they came out: That really shows that, in addition to Disney+ releasing fewer shows, those shows just don’t hit like they once did. If I had to offer one main explanation, it’s that Marvel Studios moved away from characters who starred in the Avengersmovies (The Scarlett Witch, Vision, Hawkeye, Loki, Falcon, Winter Soldier) to characters who didn’t (Moon Knight, She-Hulk, Iron Heart, Wonder Man, Daredevil). It sounds trite, but more popular IP tends to do better than less popular IP. In Marvel’s case, beloved, decades-old characters trump newer ones. And yes, I think this is a problem for Disney. The failure of Marvel TV shows to linger for weeks on the charts, unlike in 2021 and 2022, explains why Disney’s share of the charts has plummeted: That’s a strategic issue. Yes, these shows are really expensive, but without them, Disney+ will struggle, especially if Disney+ keeps raising prices AND licenses out its shows non-exclusively. My recommendation? Return to the core value proposition, which is Disney+ as “genre HBO”. The goal is six shows a year, coming out weekly, spaced out throughout the year. When a show hits, keep it coming back. Make three to four of those shows Marvel or Star Wars, and fill out the rest with IP swings like Percy Jackson, Goosebumps or something like National Treasure. And make YA-skewing shows like Coven Academy to fill out the schedule. Disney, you can get this porridge just right, er, make the right number of shows. Quick Notes on TV Netflix’s sophomore, er, junior, er, senior season slump abated very, very slightly this week. I speak of The Diplomat, which returned for its fourth season on 15-Oct. Credit where credit is due, this show debuted in April of 2023, and has put out new seasons every year since. Has that helped the viewership? Not really. This season opened to 16.4 million hours, which is down significantly from the first season (21.7 million hours) and down somewhat from the second season (18.0 million hours), but it is up from last year’s 14.2 million hours opening. On Samba TV, it opened to third place; that’s also very good. On Luminate, it opened to 25.0 million hours, which is good, but over thirty million hours is a hit on that platform. Netflix wisely renewed it, since it’s steady and, frankly, Netflix needs hits.1 Paramount+ put out Tulsa King’s fourth season on a Friday. After putting out most of their big, usually-Taylor Sheridan-scripted shows out on Sundays last year, they’ve clearly moved to Fridays going forward. Was this a thought-out strategic change, Netflix mimicry, or a data-inspired move? Tough to say. Fridays are crowded with new movies, but so are Sundays with new shows. Anyways, this one is coming out weekly, and we haven’t seen it hit the Nielsen or Luminate charts yet. But it did make Samba TV at fifth place, which is a good opening. Still, if this doesn’t make Luminate or Nielsen next week, I’d call it a disappointment. Netflix had two unscripted shows hit the charts this week, one a docu-series and one a reality competition show. Tyson is a four-episode docu-series about one of boxing’s most popular fighters, and it made both the Samba TV and Luminate charts, but not Nielsen. That’s a solid run for only four episodes (assuming it didn’t cost an arm and a leg to produce). Netflix’s latest season of Love Is Blind also returned for its eleventh season, which opened to 10.0 million hours, down from previous seasons. It also had 11.0 million hours according to Luminate, roughly in line with the Nielsen numbers. Last issue, I analyzed the triple successes of Below, Carrie and Crystal Lake, noting that all three have done well. I mostly used Nielsen, but all three shows also made Samba TV (see above). Crystal Lake in particular did very well on Luminate, getting 35.0 million hours, top for Peacock among first seasons: The top “show” of the week would have been Thursday Night Football again, at 41.7 million hours. This is still above last year’s game, but it continues the season’s overall downward trend, which happens every year. (Though a big week is coming, based on the news stories I’ve seen.) As I said before, I’ll do a deeper dive on all the October games later this month, with comparisons to previous years. One company is quietly on a roll, when you consider the shows it makes and streams. I speak of Skydance—a point Variety made—noting that it produces Neagley and Reacher for Amazon, along with Paramount+’s Lioness, which means it produced three of the top four shows of September according to Nielsen. By the way, Neagley fell off the Nielsen charts after four weeks, which is a pinch short for how well it started, but it’s still a huge success. (Interestingly, it finished just 7.3 million hours ahead of the cancelled Ride or Die.) The point, though, which I’ve made before, is that Prime Video still has a problem with how many co-productions it buys, most notably _The Boys_from Sony and Reacher/Jack Ryan from Skydance. It’s not a critical flaw—everyone licenses shows—but Amazon still struggles to make its own hits. Reacher finally fell off the Nielsen charts, so here’s its final rank for season four: We’re just getting started with this issue, but the rest is for paid subscribers of the Entertainment Strategy Guy, so if you’d like to find out… ...An example of the algorithm NOT picking a film… …whether or not Netflix buys shows simply for the movie poster… ...if East of Eden is above the Obliterated Line... ...what four star-studded straight-to-streaming films didn’t chart... ...and a whole lot more... ...please subscribe! We can only keep doing this great work with your support. If you want an idea of just how much content you’d get in a full issue, check out this older issue.
Israel’s Coalition Politics Are More Complicated Than Identity
The idea that Israel’s Jewish opposition parties can join forces with Arab parties to remove Netanyahu overlooks fundamental disagreements that make such a coalition difficult to form, let alone sustain....
Energy drinks put healthy, young people at heightened risk of cardiac arrest, heart attacks, research shows
Many people assume energy drinks 'contain no real risk,' researchers say. But their study suggests otherwise.
Report: More care is going unpaid at Wisconsin hospitals
More than 2 million patient visits at Wisconsin hospitals last year involved unpaid care, according to an annual survey of Wisconsin hospitals.
Wisconsin infant dies from measles: Health officials
It’s the first measles death in the state since 1990.
Biz Buzz: New owners rebrand Platteville pet food, grooming business; Peosta healthcare service plans expansion; gaming store opens location in Dubuque
Biz Buzz shares business tidbits from the tri-state area. This edition highlights businesses in Platteville, Wis.; Peosta, Iowa; and Dubuque.
Former OnlyFans Star Camilla Araújo Sets 'Plot Twist' Podcast Debut
Former OnlyFans creator Camilla Araújo is set to launch her first podcast, "Plot Twist," a weekly interview series featuring guests from pop culture and beyond.
The surprisingly complicated science of perfect curling ice in Wisconsin
At the Wausau Curling Club in Wisconsin, ice maker Pete Susens reveals the surprising science, precision and daily work behind perfect curling ice, where even a single human hair can ruin a shot.
AMC Entertainment Holdings, Inc. reports results for the quarter ended September 30
FORECAST CHANGESRECOMMENDATIONSThis summary was machine generated from LSEG data November 4 at 10:49 p.m. UTC. All figures in US dollars unless otherwise stated. (For questions concerning the data in this report, contact Estimates.Support@lseg.com. For any other questions or feedback, contact Refi…
D-38 business officer receives prestigious innovation award
Brett Ridgway, Lewis-Palmer School District 38's chief business officer, was honored with the Pinnacle of Achievement Award.
Early measles vaccine could help some babies as Wisconsin outbreak grows
It's another sign that Wisconsin's measles outbreak, the worst the state has seen in over 35 years, is not ending anytime soon.
Emma Thompson’s husband Greg Wise details struggles amid IVF journey: ‘The most authentic feeling of failure’
Emma Thompson’s husband Greg Wise detailed the ‘grief’ they felt throughout their IVF journey.
The surprisingly complicated science of perfect curling ice in Wisconsin
From Olympic lucky coins to microscopic imperfections, making curling ice requires an extraordinary level of precision. Just ask the ice crew in Wausau.
Celtics' Jayson Tatum reportedly has major regret over 76ers' Jaylen Brown trade controversy
Jayson Tatum and Jaylen Brown have been in the spotlight due to their ongoing beef since the Boston Celtics traded the former Finals MVP. It has been revealed what Tatum wishes he would have done early on before Brown was actually traded.
Northwestern Opens as Slight Favorite Against No. 21 Iowa
Northwestern opened as a 2.5-point favorite against No. 21 Iowa ahead of their Nov. 7 matchup at Ryan Field. The Wildcats will look to bounce back from their loss to Oregon against a Hawkeyes team coming off a 30-0 win over Wisconsin.
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.
Federation of State Physician Health Programs (FSPHP) Confers FSPHP Evaluation and Treatment Accreditation (FSPHP-ETA™) upon Palmetto Addiction Recovery Center
The Federation of State Physician Health Programs (FSPHP) is proud to announce that Palmetto Addiction Recovery Center has been awarded the prestigious FSPHP-ETA™ Accreditation, recognizing its commitment to excellence in evaluation and treatment services for medical trainees, physicians, and other healthcare workers in safety-sensitive occupational roles.
Wishing Upon Even Star Political Candidates Can Be Dangerous
UConn political science researcher finds so-called ‘wishful thinking’ correlates with such negatives as polarization, animosity toward opposing side
'These businesses must disappear': Philadelphia protest targets Jewish-owned shops ahead of Kristallnacht anni
Pro-Palestinian groups plan cycling protest targeting 6 Jewish- and Israeli-owned businesses, drawing condemnation from US senators and Jewish groups; event, scheduled on eve of Kristallnacht anniversary, raises fears of antisemitism under guise of political activism
Twist lurking in Yankees’ coaching staff conundrum
Here is the latest on the Yankees' coaching situation.
Vodafone Business Joins NYU WIRELESS as the Research Center Expands its Work on Network Resilience
Vodafone Business has joined NYU WIRELESS, the research center at the NYU Tandon School of Engineering, as an industrial affiliate, in a partnership that will connect NYU’s Brooklyn and London locations with the UK’s largest mobile operator.
Oregon was once a Republican stronghold. This politician started shifting the balance in 1954
For much of the first half of the 20th century, Oregon was effectively a one-party Republican state. Democrats had not won a U.S. Senate seat in 40 years, had not won a U.S. House seat in 18 years, and had controlled the state legislature for only four of 74 years since 1880. Into this landscape emerged Richard Neuberger, a Portland-born journalist of Jewish heritage whose prolific writing career, progressive convictions and remarkable personal drive would reshape Oregon politics.
Creator Serena Kerrigan Signs With CAA (Exclusive)
The online dating and relationships guru also starred in the Peacock comedy ‘Older, Hotter, Wiser.’
Beaver Dam now part of UW Health
BEAVER DAM, Wis. (WKOW) — UW Health officially took over the Beaver Dam medical center on Nov. 1, renaming it UW Health Beaver Dam Hospital and Clinics.The transition brings the
Infant dies from measles amid ongoing outbreak in Wisconsin: health officials
An infant has died from the measles in Wisconsin, local health officials said Thursday.
Strong Spine Chiropractic Opens Business In New Location
The Strong Spine Chiropractic has moved from its former Harrison Street location to a new office at 7 Rugby Place. The move allows the husband and wife owned business to expand both customer and building wise as their business continues to grow. Strong Spine Chiropractic is owned by Kevin Strong and Rosalie Betts. The pair […]
Wisconsin Midterm Elections 2026: Key Races, Candidates and Past Results
Learn more about the 2026 Wisconsin midterm elections. Track key races, meet this year’s candidates and see past election results.
Political analyst digs into Election Night in Wisconsin as results come in
Political analyst digs into Election Night in Wisconsin as results come in
Wisconsin reports infant death linked to measles outbreak
By Siddhi Mahatole Nov 5 (Reuters) - The Wisconsin Department of Health Services said on Thursday that an infant had died in connection with the ongoing measles outbreak in the state.
Wishing upon even star political candidates can be dangerous
Wishing really hard for something won't necessarily make it come true, but a new study from a UConn researcher indicates up to 90% of voters expect their side to win an election, a percentage that's significantly ...
UW-Stevens Point Soil Judging Team takes 3rd at Regionals
The University of Wisconsin-Stevens Point (UWSP) Soil Judging Team earned a third-place overall finish at the 2026 Regional 3 Soil Judging Contest, hosted by The Ohio State University in Ohio, Oct.
In Chatsworth, N.J., Rutgers Scientists Farm for the Berry Best Varieties
During a mostly sunny Friday morning in early October, 11 students squatted in a basin, picking cranberries from low-creeping vines and placing them into clear plastic bags. “Do not eat them,” said Peter Oudemans, a professor of plant biology and pathology with the Rutgers School of Environmental and Biological Sciences. He was sort of kidding – and sort of not.
Predators’ Chris MacFarland breaks silence on Shane Wright trade
The Nashville Predators acquired Shane Wright in a trade with the Seattle Kraken on Sunday. This ends a bit of a saga within the Kraken. Wright has preferred a trade out of Seattle for a while now. He finally got his wish with this move. The newest Predators forward has had a rollercoaster of a career to this point. He was never able to establish […] The post Predators’ Chris MacFarland breaks silence on Shane Wright trade appeared first on ClutchPoints.
Anthology by local editors imparts wisdom, advice to young women
“Uncertain Girls in Uncertain Times” includes essays from 40 contributors around the country, as well as poems that mirror their life experiences.
New York health officials report 1st measles death in 3 decades
The New York State Department of Health and Lewis County Public Health yesterday reported the first known measles-associated death in New York State in more than 30 years. State health officials state: “The Department has offered resources to Lewis County to assist with community outreach and support local vaccination efforts – both in response to this c…
The German Makkabi sports club where Muslims outnumber Jews
When they sweat it out at a big German sports club, Jewish, Muslim and other athletes are also sending a strong signal against rising antisemitism, the...
RWJBarnabas Health and Rutgers Cancer Institute Researchers Contribute to Study Supporting Shorter Radiation Treatment for Breast Cancer Patients
Bruce Haffty, MD, associate Vice chancellor for Cancer Programs at Rutgers Cancer shares about the findings of a recent Journal of Clinical Oncology study supporting shorter radiation treatment for breast cancer patients.
Heichal HaTorah Talmidim Experiment in the Science Lab
This past week, Heichal HaTorah’s ninth-grade biology students learned how to use indicators to test the pH levels of common household solutions. Students observed a wide range of colors as natural plant-based pigments (anthocyanins) in red cabbage juice reacted with acids and bases in everyday substances. Students made predictions and determined whether a substance was […]
UWL hosts small business summit
LA CROSSE (WKBT) -- The University of Wisconsin-La Crosse hosted the Wisconsin Small Business Summit today at the Student Union, giving new and established businesses a chance to explore topics
Health and Career Fair set for Thursday at Black Oak | Lewis County Herald The Lewis Co. Herald
Free health screenings, discounted laboratory testing, blood donations, employment opportunities, and workforce training information will be available The Lewis County Health and Career Fair will be held Thursday, November 5, at the Black Oak Volunteer Fire Department, bringing together healthcare providers, employers, and workforce development organizations for health screenings, blood donations, employment opportunities, and educational […]
I lost my period for two decades — I wish I had known what I know now
A former patient shares her struggle with hypothalamic amenorrhea and advocates for better education on the menstrual cycle as a vital sign.
Sphere Entertainment Co. reports results for the quarter ended September 30
FORECAST CHANGESRECOMMENDATIONSThis summary was machine generated from LSEG data November 5 at 03:55 p.m. UTC. All figures in US dollars unless otherwise stated. (For questions concerning the data in this report, contact Estimates.Support@lseg.com. For any other questions or feedback, contact Refi…
AI boosts operational efficiency but not systemic climate action, global study finds
Artificial intelligence (AI) is widely promoted as a tool for sustainable development, but whether its operational gains translate into deeper ecological transformation remains uncertain. A new global assessment examines how AI diffusion relates to seven core United Nations Sustainable Development Goals (SDGs), covering health, education, clean energy, industry and infrastructure, sustainable cities, responsible consumption and production, and climate action. It also explores the channels behind
Will Lawmakers Heed the Call for More Affordable Health Care by Expanding Medicaid in TX, GA, KS & WI?
Over the last year there hasn’t been much discussion around creating more affordable health coverage in the last ten states that haven’t expanded Medicaid. But yesterday’s election dramatically changed the political status quo in at least four of the non-expansion states: Georgia, Kansas, Texas, and Wisconsin. That makes Medicaid expansion more viable in those states […]
Why Youth Are Turning to AI for Mental Health Advice
Hannah Simon — a child and adolescent psychiatrist and the medical director of the Brandt Behavioral Health Treatment Center and Retreat at Rutgers, which provides evidence-based behavioral health care and outpatient services to New Jersey youth and young adults — discusses the increased use of chatbots for mental health advice and best practices for using it as an educational tool.
Philadelphia bike rally targeting Jewish businesses condemned; police prioritize safety
A planned bike rally targeting Jewish and Israeli-owned businesses in Philadelphia has drawn statewide condemnation, with police prioritizing safety.
Middleton boys volleyball sweeps Mukwonago, heads to state championship
GREEN BAY, Wis. (WKOW) — The Middleton boys volleyball team will play for another championship Friday night.
400,000-year-old teeth reveal a stunning twist in human evolution
A groundbreaking discovery is rewriting the story of human evolution, revealing that an ancient human species once thought to be an evolutionary dead end may have left genetic traces in people alive today. By extracting proteins from 400,000-year-old Homo erectus teeth discovered in China, scientists uncovered evidence suggesting that these early humans interbred with Denisovans, another mysterious ancient human group. That genetic connection may have eventually reached modern populations in the Philippines, Papua New Guinea, and other parts of Southeast Asia.
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.
USDA revising cost-share requirements for Dairy Business Innovation
MADISON, Wis. (WKOW) — The U.S. Department of Agriculture is revising cost-share requirements for the Dairy Business Innovation Initiatives program after discussions with the four DBI centers and dairy industry
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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