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Most AI health equity guidance is general and U.S.-based, Georgetown review finds
Only 22 of the articles in a Georgetown scoping review defined health equity, a gap the lead author said could steer resources toward the most advantaged groups.
Two juveniles charged in assault of Charleston business owner, police say
Two juveniles have been charged in connection to the assault of a business owner on Charleston's West Side, police said.
Explore events for small businesses across Pa. during Global Entrepreneurship Week at Penn State
Global Entrepreneurship Week Penn State will bring entrepreneurs, business owners, students and community members together through events across central Pennsylvania and the commonwealth, offering networking, workshops and opportunities to connect with local businesses and entrepreneurial resources.
ECU Health home health and hospice services to transition to Liberty Home Care & Hospice
ECU Health’s home health and hospice services has finalized an agreement to transition to Liberty Home Care and Hospice on Nov. 1, ECU Health said.The sale incl
West Virginia state workers see moderate rise in health care costs with new PEIA plan
Agri science key climate change tool, say experts
Agricultural science and technology is expected to play a greater role in international cooperation as countries face mounting pressures from climate change, resource constraints and disruptions to food supply chains, experts said on Monday at a global forum in Hainan province.
Ohio State earth science professor Lonnie Thompson dies after brief illness at 78
Ohio State University is mourning the loss of a longtime professor whose work helped elevate the university’s global reputation in climate research.OSU Presiden
Fayetteville PWC to host Veterans Business Expo Nov. 12
The Fayetteville Public Works Commission (PWC) will host a Veterans Business Expo on Thursday, Nov. 12, 2026, from 4:00 p.m. to 6:00 p.m. at PWC's Main Operations Complex, located at 955 Old Wilmington Road in Fayetteville. The event will provide Veteran-owned businesses with an opportunity to showcase their products and services directly to government entities, public agencies, contractors and resource partners. The expo is designed to encourage networking, strengthen business relationships and connect Veteran entrepreneurs with potential opportunities for growth and collaboration. The Veterans Business Expo reflects PWC's ongoing commitment to supporting local businesses, fostering economic development and creating opportunities for businesses throughout the Fayetteville and Cumberland County community. The event is being promoted in collaboration with the Veterans Business Outreach Center at FSU (VBOC) and the Fayetteville-Cumberland Regional Entrepreneur & Business HUB.
'Total loss of the business': Firefighters battled structure fire
The Bedford Fire Department said no injuries were reported after a fire early Monday morning.
PRG PROJECTS OPENS NEW LONDON STUDIO TO COLLABORATE WITH LIVE ENTERTAINMENT'S CREATIVE COMMUNITY
PRG Projects, part of global entertainment technology company PRG (Production Resource Group), today announced the opening of Project Studio, a new collaborative space in central London that expands the company's custom engineering and technology integration capabilities, bringing its technical expertise closer to the creative teams shaping the future of live entertainment.
Political controversies roil key races in final days before midterms
A series of last-minute controversies have roiled races in the final days before the midterm elections, injecting new uncertainty into tight races.
Fresno’s growth boosts small businesses and housing demand as more families put down roots
Fresno is seeing significant population growth, and local real estate professionals say more people are choosing to call the Central Valley home.From a thriving
Normal Aging or Something More? Memory Changes You Shouldn't Ignore
When changes in memory, thinking or behavior begin interfering with everyday life, they deserve closer attention.
Nashville small businesses question whether city Legacy Business program offers any relief
Nashville Mayor Freddie O'Connell and the Metro Council have approved a Legacy Business Program intended to help longtime small businesses facing rising costs.
IMF–World Bank Group Annual Meetings 2026: A global development platform and WHO’s engagement on health
Investing in health, investing in development
Political controversies roil key races in final days before midterms
A series of last-minute controversies have roiled races in the final days before the midterm elections, injecting new uncertainty into tight races.
Inaugural ROC Startup Week celebrates Rochester's entrepreneurs and small businesses
Rochester's startup community came together Monday night to kick off the inaugural ROC Startup Week, a six-day celebration of local entrepreneurs, small businesses and innovation.
Ko A-sung Reveals Early Start in Entertainment via Baby Model Contest
Ko A-sung Reveals Early Start in Entertainment via Baby Model Contest Actors street casting at four led to entertainment career; Park Jeong-min calls it impressive
The Best Time to Fix Your Business Is When Things Are Going Well by Nathan Tayloe
There's a pattern I've noticed working with growing businesses over the years. Conversations about what needs to change rarely happen when things are going well. They tend to happen when growth slows, a competitor starts winning business, or something that used to work stops producing the same results. By then, the decisions are often harder, more expensive, and more urgent than they needed to be. It's understandable. When revenue is growing, customers are coming in, and employees are busy, there's little incentive to question what's working. Leaders have plenty to manage without creating new challenges for themselves. Running my own business has taught me that it's easy to get caught up in what's happening today and put off improvements you know will matter tomorrow. Those periods of success may actually be the best opportunity a business has to make meaningful improvements. When Success Makes Change Less Urgent Most businesses have things they know could be better. The challenge is finding a compelling reason to address them when everything appears to be working. Maybe the company has outgrown its original positioning. Perhaps internal processes haven't kept pace with growth, or the customer experience has become inconsistent as the organization has expanded. These issues don't necessarily prevent a business from growing. Strong demand can make them easier to overlook, especially when teams are focused on keeping up with the work already coming in. Over time, small inefficiencies become accepted ways of operating. Outdated processes remain in place because they've always worked well enough, and opportunities to improve get pushed aside in favor of more immediate demands. The business continues moving forward, but some of the things supporting that growth aren't getting stronger along with it. The Advantage of Acting Early When a business is performing well, leadership has something valuable: options. There's more flexibility to invest, experiment, develop people, and make thoughtful decisions without the pressure of an immediate problem that needs solving. Compare that with trying to make the same changes when revenue is declining, or the market has shifted. Investments become harder to justify, timelines get compressed, and decisions that could have been made strategically become urgent responses to circumstances. I've seen businesses postpone improvements for years because there was never a particularly good time to address them. Eventually, circumstances decide for them, often when they have fewer resources and less flexibility to respond. Growth Changes What a Business Needs This is especially relevant in a growing market like Wilmington, where new businesses, new residents, and continued investment are creating opportunities across the region. As organizations grow, the expectations placed on them change. Customers expect greater consistency, employees need clearer processes and opportunities, and leadership has to make decisions that support a larger, more complex business. What worked when a company was smaller may still work today, but that doesn't necessarily mean it will support where the organization wants to go next. Sometimes the most valuable improvements are the ones that prepare a business for demands it hasn't experienced yet. That might mean: Strengthening internal processes before they become bottlenecks Developing leaders before the organization depends on them Improving the customer experience before inconsistencies affect retention Revisiting positioning before the market outgrows the company's story None of these changes requires a crisis. They require recognizing that a growing business needs to keep evolving, even when current performance gives leadership little reason to worry. Use the Good Years Wisely Successful businesses don't need to constantly reinvent themselves. There's value in knowing what works and having the discipline to build on it. There's also value in occasionally asking whether the business is as strong as its current performance suggests. Are there problems we've learned to work around instead of solving? Are we still operating the way we did several years ago, even though the business has changed? What would we improve today if we weren't waiting for something to go wrong? Success creates the freedom to ask those questions and act on the answers. The businesses that make the most of that opportunity are often better prepared for whatever comes next. The strongest businesses don't need a crisis to recognize an opportunity to improve. They use the good years to prepare for the years ahead. — Learn more about how we help organizations strengthen their positioning, align their strategy, and prepare for what's next at tayloegray.com, or reach out directly at nathan@tayloegray.com.
Arkansas Health Insurance Marketplace enrollment open until January 2027
Enrollment for Arkansas Health Insurance Marketplace is now open until January 15, 2027 for beneficiaries to review,
Nine people killed after jet from Austin crashes in Florida, transportation secretary says
At least 9 people are dead after a business jet flying out of Austin crashed in a Florida neighborhood, U.S. Transportation Secretary Sean Duffy said.The Federa
Four dead, 15 injured in three shootings on Halloween across Dallas entertainment district
'Everyone loved him': Asheville remembers longtime business owner who died in crash
For more than three decades, Nicholas "Nick" Papanastasiou brought people together through food, friendship and community.
The context problem: How Docusign built agents that understand the business behind contracts
Docusign CTO Sagnik Nandy explains how Iris gives AI agents the context they need to understand contracts and act on them
Oregon data shows flu shots drop to 52% among health care workers in 2025-26 season
OHA offers data, tools and resources to encourage more healthcare workers to vaccinate against the flu. Only 52% of healthcare workers are currently vaccinated.
An AI Called LUMINA Is Being Taught to Pick Safe Landing Sites on the Moon
Ohio State researchers unveiled LUMINA, an AI framework meant to help planners choose safe, resource-rich Moon landing sites, with Mars as a possible later target.
Slack vs Discord; a comparison for businesses
Slack vs Discord were built for different audiences, one for work, one for communities. See which platform actually fits business teams best.
Kids’ health questions? Check out these 8 doctor-approved resources
JAMA Patient Pages offer parents easy-to-understand updates on concussions, autism screening, chest pain in kids, bug repellents and more.
NANCY GUTHRIE | After 9 months, investigators turn to Florida scientists for new DNA leads
Arizona investigators working on the Nancy Guthrie case are continuing DNA testing with laboratory partners, according to authorities.
Night out turns violent as gunfire erupts outside La Cantera-area business
KABB Fox News 29 San Antonio provides local news, weather forecasts, traffic updates, investigations, notices of events and items of interest in the community, sports and entertainment programming for San Antonio and nearby towns and communities in South Central Texas, including Bandera, Boerne, Carrizo Springs, Castroville, Cibolo, Converse, Crystal City, Cuero, Del Rio, Devine, Eagle Pass, Floresville, Fredericksburg, Goliad, Helotes, Hondo, Kerrville, Live Oak, New Braunfels, Pearsall, Pleasanton, Poteet, Poth, Sabinal, San Marcos, Seguin, Schertz, Somerset, Universal City, Uvalde, Windcrest.
Need healthcare, but worried about the cost? These free health clinics are happening monthly in Fluvanna
The clinics offer health screenings, private doctor visits, Medicaid assistance, food and other resources on the first Thursday of each month. The next clinic is on Nov. 5.
Women connect with health resources at UPMC’s Pretty in Pink evening
Hundreds of women attended UPMC’s annual Pretty in Pink event, which connected attendees with community and health resources.
DEA approvals could bring big tax benefits for medical marijuana businesses
The U.S. Drug Enforcement Administration has for the first time issued registrations to medical marijuana dispensaries, a bureaucratic maneuver under President
Old Forge Dry Cleaning business destroyed by early morning fire
Just after 1 AM on Halloween Morning, crews responded to a large fire inside of the Lease Dry Cleaners building on Oak Street that is now demolished.
Misericordia opens LEAP Center, uniting exercise science labs with athlete training
FOX56 WOLF TV carries news, sports, weather and coverage of local events in the Wilkes-Barre, Pennsylvania area, including Mountain Top, Plymouth, Nanticoke, Kingston, Back Mountain, Scranton, Moosic, Pittston, Avoca, Edwardsville, Hilldale, Wyoming, Laflin, Yatesville, Pittston, Dupont, Sugar Notch, Korn Krest, Warrior Run and Larksville.
Watch Nevada Sports Net's Mountain West men's hoops preview show ahead of 2026-27 season
A new era of Mountain West men's hoops begins on Monday. Nevada Sports Net put together a 30-minute special previewing the upcoming season, hosted by Shannon Ke
11 juveniles involved in Arlington business robbery
An investigation is underway into a robbery involving at least 11 juveniles Monday night in Arlington.
CBS Sports reporter clashed with Connor Stalions over doctored FSU HC candidate image
After an uninspiring 3-5 start to the football season, Florida State announced Sunday that it had fired head coach Mike Norvell. Speculation about who might replace Norvell began as early as September, but now that the move is official, more names are being linked to what is expected to be one of the most resource-heavy…
PRG PROJECTS OPENS NEW LONDON STUDIO TO COLLABORATE WITH LIVE ENTERTAINMENT'S CREATIVE COMMUNITY
/PRNewswire/ -- PRG Projects, part of global entertainment technology company PRG (Production Resource Group), today announced the opening of Project Studio, a...
Business jet carrying 9 people crashed in a Florida neighborhood, erupting in flames
WOAI NBC News Channel 4 San Antonio provides local news, weather forecasts, traffic updates, investigations, and items of interest in the community, sports and entertainment programming for San Antonio and nearby towns and communities in South Central Texas, including Windcrest, Uvalde, Universal City, Somerset, Seguin, Schertz, San Marcos, Sabinal, Poth, Poteet, Pleasanton, Pearsall, New Braunfels, Live Oak, Kerrville, Hondo, Helotes, Goliad, Fredericksburg, Floresville, Eagle Pass, Devine, Del Rio, Cuero, Crystal City, Converse, Cibolo, Castroville, Carrizo Springs, Boerne, Bandera.
TeacherFest 2026 to bring mental health, wellness resources to Lowcountry educators
A Charleston-based nonprofit is hosting a free community event aimed at providing mental health and wellness resources for local educators.
Great Alaskan Holidays Appoints HR Manager
Great Alaskan Holidays hired experienced HR professional Terri Jerue as the RV rental, sales, and service company’s Human Resources Manager.
Americans open to AI in health care but want humans calling the shots
A new survey from the Pew Research Center shows Americans are open to the use of AI in some areas of medicine, but they're far from ready to hand the reins of their health care over to the technology.
All 9 people aboard Business jet from Austin killed after crash in Florida neighborhood
KABB Fox News 29 San Antonio provides local news, weather forecasts, traffic updates, investigations, notices of events and items of interest in the community, sports and entertainment programming for San Antonio and nearby towns and communities in South Central Texas, including Bandera, Boerne, Carrizo Springs, Castroville, Cibolo, Converse, Crystal City, Cuero, Del Rio, Devine, Eagle Pass, Floresville, Fredericksburg, Goliad, Helotes, Hondo, Kerrville, Live Oak, New Braunfels, Pearsall, Pleasanton, Poteet, Poth, Sabinal, San Marcos, Seguin, Schertz, Somerset, Universal City, Uvalde, Windcrest.
67% of security leaders say their teams struggle to meet business needs
Growing AI demands and compounding skills gaps are taxing the resources and effectiveness of cybersecurity teams.
Flutter Entertainment PLC: Q3 2026 Earnings Release
NEW YORK, Nov. 04, 2026 (GLOBE NEWSWIRE) -- Flutter Entertainment plc (NYSE: FLUT) (“Flutter”), the world’s leading online sports betting and iGaming...
AFT Expands National Soil Health Demonstration Trial Network with nearly $5 Million from USDA
The United States Department of Agriculture (USDA) Natural Resources Conservation Service (NRCS) is awarding American Farmland Trust (AFT) nearly $5 million over five years through its Conservation Innovation Grants On-Farm Trials program to help expand AFT’s national network into a coordinated Soil Health Management Systems (SHMS) Network. Working with 35 trial host farms across 14
The Dalton Can’t Wait
The Dalton Highway is essential infrastructure for the North Slope. What improvements does it need to support resource development?
Texas just went blue, and the tech bros are sad
Texas, with its limited red tape and vast resources, drew in the tech crowds. Now, it's politics turned bluer, and the execs are a little upset.
Georgia Football Needs a Strong Economy, Not an Uncertain Business Climate Under Keisha Lance Bottoms
ATHENS, Ga. — Georgia football operates in an increasingly complicated financial environment. The Bulldogs compete against programs with enormous resources, sophisticated recruiting operations and growing NIL budgets. Maintaining that advantage requires Georgia to remain an attractive destination for businesses and major donors. Keisha Lance Bottoms’ proposed pause on new data center construction deserves scrutiny from…
A place to belong: Why connection matters in mental health
Birch Tree Communities helps Arkansas adults living with serious mental illness build friendships, find belonging, and feel supported throughout recovery.
Americans open to AI in health care but want humans calling the shots
A new survey from the Pew Research Center shows Americans are open to the use of AI in some areas of medicine, but they're far from ready to hand the reins of their health care over to the technology.
Which small businesses need cyber liability insurance most?
By Mary Beth Eastman for ERGO NEXT Data from the nonprofit Identity Theft Resource Center’s 2025 Business Impact Report found that 81% of small businesses surveyed reported a security breach, a data breach, or both in the last year. Cyber liability insurance could help protect small businesses from some of the costs of data breaches,
5 Of The Best Leatherman Multitools For Gardening
From pruning stubborn branches to fixing garden fixtures, these Leatherman multitools are resourceful companions that won't get dusty in your garage.
Community Health Fair connects Normaltown neighbors with UGA resources
A group of UGA schools and colleges united to promote community health resources during the annual Normaltown Community Health Fair.
Halloween meets game day: How Sixth Street is preparing for a packed night
With Halloween and a University of Texas game bringing crowds downtown tonight, APD expects 80,000 to 100,000 people in the entertainment districts...
Hortonville reopens Main Street, hopes to help businesses who lost traffic due from HWY 15
Hortonville reopened Main Street after three months of renovations, the first since 1958.
Caldwell Mayor gives update on city business before heading to Israel
Caldwell is moving ahead with major public safety projects, park improvements and a search for a new police chief, Mayor Eric Phillips said in a series of updat
Texas Tech Health Sciences Center launches CenteringPregnancy program in Amarillo
Southcoast Health CEO steps down; interim leader named
Southcoast Health President and CEO David McCready stepped down Friday, effective immediately, according to a message sent to employees by the health system’s b
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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