25 Years in Healthcare: What I've Learned About Leading Through Uncertainty

In August 2014, I was managing programmes across Nigeria, Liberia, and Sierra Leone when the Ebola outbreak escalated into a full regional health emergency. Within ten days, two of our country operations were effectively suspended. Staff were evacuated or sheltering in place. Supply chains were disrupted. The entire operating assumption of our programmes — that we could move commodities, staff, and information across borders with reasonable predictability — had collapsed.

I remember sitting in our Abuja office at something like 11pm, on a call with our country directors, trying to make decisions about whether to pull our community health workers back from field operations in Liberia. The data was incomplete. The risk assessments were contradictory. My gut was telling me one thing; the operational logic was telling me another.

There was no playbook for this. Nobody in our organisation had managed an Ebola-era programme suspension. I had to make calls in real time, with imperfect information, knowing that the consequences — in either direction — were serious. Pull back too early and we abandon the communities depending on our malaria programmes during a period of extreme health system stress. Stay too long and we risk the lives of our own staff.

That period compressed something like ten years of leadership learning into about three weeks. And a lot of what I thought I knew about leading people through difficulty turned out to be incomplete.

I want to share what I actually learned — not the version that sounds good in a training room, but the version that came out of that specific, difficult experience and the many others like it over twenty-five years.

What I Got Wrong About Certainty

Early in my career, I believed that good leadership required projecting certainty. Your team needed to feel that you knew where you were going. Uncertainty was something to manage privately and present publicly as confidence.

That approach works tolerably well in stable environments. It fails, sometimes catastrophically, when the ground is actually shifting.

What I learned in 2014 — and what I have continued to learn in the years since — is that the leaders who navigate genuine uncertainty most effectively are not the ones who project certainty. They are the ones who create safety within uncertainty. There is a meaningful difference.

Creating safety within uncertainty means being honest with your team about what you do not know. It means saying "I don't have complete information, here is what I do have, here is how I am thinking about it, here is the decision I am making and why, and here is how we will review it if the situation changes." It means treating your team as adults capable of handling complexity rather than as anxious children who need false reassurance.

The teams that performed best during our Ebola-related disruption were the ones where country directors had built that kind of honest, open culture. They could adapt quickly because information flowed freely and people felt safe surfacing problems without fear of being blamed for raising bad news.

The Lesson About People That Took Me Too Long to Learn

I am going to be honest about a failure here, because I think it is more useful than presenting a clean lesson.

For the first decade or so of my career, I was primarily focused on the technical and operational dimensions of my work. I was good at understanding health systems, designing programmes, navigating supply chains. I was less good at investing in the people around me as people, rather than as roles in an organisational structure.

There was a programme manager I worked with in the early 2010s — I will call her Adaeze — who was exceptionally talented and visibly struggling under a management structure that was not giving her the space to grow. I noticed it. I did not act on it, because I was busy, and because I told myself it was not directly my responsibility. She left the organisation within a year. Three years later, I ran into her at a conference. She had gone on to build something remarkable at another institution.

I have thought about that situation many times since. The opportunity cost — to her, to our programme, to the relationships we could have built — was real. And it was avoidable.

The shift I made after that, which I now consider the most important evolution in my leadership practice, was to treat developing people as a primary work output — not a nice-to-have, not something for when I have more time, but an explicit deliverable that I was accountable for as a leader.

That shift changed how I structured my calendar, how I ran team meetings, how I thought about succession. And the outcomes — in retention, in programme quality, in the satisfaction I now take from this work — have been disproportionate to the effort it required.

On Adaptability: The Version Nobody Tells You

In leadership development circles, adaptability is celebrated almost universally. Adapt quickly. Embrace change. Pivot boldly. The messaging makes it sound clean.

The reality I have lived is messier. Real adaptability — the kind that health systems leadership demands — is often uncomfortable and occasionally involves admitting publicly that a previous direction was wrong. That is a specific kind of courage that is harder than most people acknowledge.

I have had to change direction on programmes I had publicly championed. I have had to tell funders that the approach we agreed on six months ago was not working and needed to be revised. I have had to go back to government partners and say "the model we designed together is not producing the outcomes we projected — here is what the data shows, and here is what I believe we need to do differently."

Every time, there was a version of me that wanted to defend the original position, to find the narrative that made the underperformance look like something other than what it was. And every time, the better choice — the choice that preserved trust and enabled the next phase of the work — was to be honest about what the data showed and direct about what needed to change.

Adaptability is not just flexibility of strategy. It is the willingness to be wrong in public and to learn from it without losing your footing. That takes practice. And some humility that, honestly, I am still working on.

The Question I Return To

Twenty-five years is a long time to be in any field. Long enough to accumulate both accomplishments and regrets in roughly equal measure. Long enough to know that the arc of a career in public health is not a straight line toward mastery, but an ongoing negotiation between what you know and what the work keeps teaching you.

The question I return to, more often now than in my earlier years, is simply: am I making the right people better? Not just the programmes. Not just the numbers. The people.

If the answer is yes, then I believe the rest of the work will follow. If the answer is no, then everything else — the strategy, the innovation, the impact metrics — is built on sand.

I do not have this figured out. But I am more committed to that question than to any other measure of my own success. That, perhaps, is what twenty-five years has taught me most.