She planned to study medicine when she left Uganda for the United States of America, but experiencing first-hand the challenges within the health system that prevented doctors from providing quality, accessible health care to all convinced Esther Lwanga to pivot to public health, where she works to influence the policies and interventions that seek to empower health workers and the communities they serve.
Now a seasoned global health development expert and a staunch advocate for the empowerment of African girls and women through mentorship, Ms. Lwanga shares insights into her experiences as a woman in global health and calls for greater investment in uplifting African women to health leadership positions. Read her story below.
What inspired you to work in health?
I went to college in the United States to pursue a medical degree. During my freshman year, I gained a clearer picture of the medical system, what it meant to serve one patient at a time in a clinic setting or hospital and the limitations that came with that.
In a capitalist society, the health system, like all businesses, is driven by profits, whereby healthcare is a commodity to be bought and sold, driven by health insurance companies and monetary transactions that severely limit access for underserved and uninsured populations. A system where a physician’s decisions are not solely driven by science but are in fact heavily impacted by regulations, policies, laws and actors that do not always put the patient first.
It was during this time that I learnt about the fields of health care administration and public health, its focus on disease prevention and addressing community and population needs. I switched my major and have been working to strengthen health-related programs and policies since.
There is a saying that one should choose their first job wisely, as that defines your exposure to different ways of working, leadership and management, ethics and integrity, and how to get things done.
I began my career working for a health association in the Washington DC Metro area before transitioning to USAID, where I supported a health research portfolio for five years. Since then, I have been privileged to work in relatively positive and dynamic environments with teams and individuals who are dedicated to their work, including my
first supervisor Miguel McGinnis, CEO of the Mid-Atlantic Association of Community Health Centers, who was key to setting the foundation upon which I have based my career.
In the area of global health, which varies greatly by country, culture and context, I identify as an African, Ugandan, a woman, a black woman, a wife, a mother, and majority of the time, as a technical expert.
But I also realize that as a woman, the recognition of my identity has been defined in comparison to those in the room. I recall driving two hours to a meeting in Delaware once, entering the conference room to find about six African American men sitting around the table. That day, I was a woman.
How have these experiences shaped your view of global health, and how has this impacted the way you work?
From a leadership perspective, my hope is for an increasingly African-led and driven agenda for health initiatives and activities on the continent.
A few years ago I worked with a key donor agency in Washington DC where the headquarters of many international non-governmental organizations (INGOs) are located. In reading applications in response to Requests for Proposals, the vast disparity in the capacity of INGOs and local organizations to outline their ideas was reflected time and time again. Local institutions need significant resources to implement evidence-based solutions and drive sustainable change on the ground. But they often lack the capacity to articulate their ideas in a compelling way to donors and then may face administrative and financial challenges in stewarding large grants.
Living and working in Nairobi, Kenya now, my work focuses on supporting the acquisition of resources at the local level and strengthening systems, processes, and individual capacities to successfully implement programs.
What gaps do you see in global health leadership. especially in relation to gender and equity from the perspective of an African woman in health?
From my perspective, gaps in global health leadership vary when one considers INGOs, donors, local NGOs, government actors and those working in the private sector.
The majority of INGOs are led by Caucasians, mainly male. While at the local level, I see a burgeoning of African women as Executive and Country Directors and heads of large influential health programs, this number remains comparatively small. African women mainly achieve senior and middle management roles, but rarely get into global health leadership at the senior-most levels.
It’s important to reflect on the push and pull factors that lead to this including gender biases, how we as African women navigate our work environments and the traditional home management role that many African women still play.
What must be done to support more African women to rise to position of leadership in health?
We know that majority of individuals working within global health are women. As African women, we have degrees and technical expertise. It’s the application of those soft skills and political savviness that continue to challenge us.
Exposing African women to new ways of thinking, working, communicating and operating through training, forums, groups, books and other resources can begin to move the needle. African women need to drive the change. In addition, institutions need to ensure that their policies (stated and unsaid) and principles facilitate a culture for change.
What impact do you think initiatives such as WomenLift Health’s Leadership Journey can have on representation across all levels of leadership within health?
The Leadership Journey is planting not just one, but almost 90 leadership seeds annually across the globe of women with the interest, technical expertise, and motivation to lead. It is building a strong leadership foundation by giving women the knowledge, practical skills, and networks. By providing very practical ways to approach leadership, this program, and others like it, are giving women the tools to lead, and I do feel that there is a potential for a snowball effect.
As a member of the first East African cohort of the Leadership Journey, what would you say your highlights of the training and mentorship program have been over the past six months?
This is an intensive leadership journey that provides in-depth, practical, holistic approaches to leading as a woman in global health.
The early part of the program included an intensive assessment conducted anonymously by 10 or more peers on 8 different leadership competencies. I can say that while I participate in multi-rater feedback annually at my organisation, I have never received such detailed, specific, and useful critique on almost 100 individual indicators of my leadership. With a view to leadership effectiveness, an additional assessment looked at my influencer style and where it may, or may not, achieve the intended change.
Work-life balance has also been emphasised throughout the course and the realities of navigating our professional versus personal spaces. Beyond the monthly sessions, individual coaching, and group mentorship, I have greatly appreciated – and I am constantly inspired by – the women in this cohort who are walking this journey with me, drawing lessons from their experiences within their respective environments.
What are the biggest lessons you’ve drawn from the Leadership Journey?
I am continuously reminded of the need to pause, step back and reflect specifically on what, why and how I am moving forward. Whether it is how I engage with those around me, external perspectives versus my own views of myself as a leader, how I drive change, my brand and messaging, and so on.
Leadership is a journey that never ends, no matter the role. To continue to grow as a leader I must be able to holistically reflect on my actions and determine what I must do to successfully align my intentions with any resulting outcomes.
Do you have any words of advice for women in health looking to progress into positions of Leadership?
I believe we are all learning in an increasingly disruptive and changing world. My advice to women who would like to take on leadership roles would be to carefully choose and know your village (who are the 3-5 people that will both positively push and encourage you?); intentionally build and maintain your network; know your brand and your why (what’s driving you beyond titles and hierarchies); and continue to invest in yourself – never stop growing technically, strategically, emotionally, and mentally.