Leading in a system that is being rebuilt in real time

There is a shift happening in leadership, one that is not always visible but is increasingly difficult to ignore.

For many of us working across health systems, development, and public-private partnerships, the markers of success are changing. Delivery still matters. Execution still matters. But they are no longer the differentiators they once were.

“In environments where resources are tightening and expectations are expanding, the ability to make those decisions well and to make them consistently becomes one of the most important leadership capabilities.”

At a certain level, leadership becomes less about what you can deliver yourself and more about what you can enable, sustain, and strengthen beyond you.

And that shift is happening at the same time the systems we operate in are being tested, stretched, and, in some cases, fundamentally reconfigured.

Recent global conversations have pointed to something many of us are already experiencing in practice; we are operating in a system that is no longer stable, yet not fully rebuilt.

That reality changes the nature of leadership. It requires a different kind of clarity. Not just clarity of strategy, but clarity of judgement.

The move from execution to discernment
Earlier in our careers, leadership is often defined by action, how quickly we can move, how much we can deliver, and how effectively we can solve problems.

But as complexity increases, the work becomes less about volume and more about discernment.

What do we focus on? What do we build? What do we let go of? These are no longer secondary questions. They are the work.

In environments where resources are tightening and expectations are expanding, the ability to make those decisions well and to make them consistently becomes one of the most important leadership capabilities.

This is especially true in health systems and development, where the stakes are high, the variables are many, and the margins for error are often small.

Leadership at this level is not about doing more. It is about choosing better.

Working within systems we do not fully control
One of the more honest reflections emerging from recent global discussions is that many of the systems we rely on, funding, governance, and delivery, were not originally designed for the level of complexity we now face.

Yet, we are not operating outside those systems. We are deeply embedded within them.

This creates tension.

On one hand, there is increasing recognition that we need to think differently about power, about trust, about how resources flow, and about how decisions are made.

On the other hand, the structures we work within still shape what is possible in practice.

Navigating that tension is now part of leadership. It requires both realism and ambition. Realism to understand the constraints. Ambition to continue building toward something better.

From programs to systems that endure
There is also a growing understanding that the long-term value of our work is not defined by the number of programmes delivered but by the strength of the systems those programmes leave behind.

This is not a new idea. But it is becoming more urgent.

As traditional funding models shift and institutional trust fluctuates, the question is no longer just whether services are delivered, but whether the underlying systems are strong enough to continue delivering without constant external reinforcement.

In practical terms, this means strengthening government capacity rather than stepping in to replace it, aligning partners around shared outcomes instead of fragmented, parallel efforts, and investing deliberately in the digital, operational, and human infrastructure that can scale and sustain results over time.

In many ways, this is slower, more complex work. But it is also more meaningful. Because systems, when they are built well, outlast any single intervention.

The coordination challenge
Another reality we are confronting is that there is no shortage of effort. Across the sector, there are capable actors, strong ideas, and genuine intent.

Yet impact is often constrained not by lack of activity, but by misalignment.

Different incentives. Different timelines. Different definitions of success.

This is where leadership becomes less about control and more about coordination.

How do we bring actors together in a way that is not just collaborative in principle, but aligned in practice?

How do we create clarity where there is fragmentation? How do we move from parallel work to shared progress?

These are not easy questions. But they are increasingly central to the work.

Leading with humility and intent
Perhaps one of the most important shifts required at this moment is not technical, but personal.

A shift in how we see our role.

Leadership in this context requires a level of humility, an acknowledgement that no single institution, partner, or individual has all the answers.

It also requires intent, a willingness to be deliberate about where we focus, how we engage, and what we prioritise.

This is particularly important in global development, where there has historically been an imbalance in how solutions are defined and applied.

There is now a growing recognition that leadership must be more inclusive, more locally grounded, and more responsive to context.

Not as a principle, but as a practice.

A moment of transition and opportunity
It would be easy to describe this moment as uncertain. And in many ways, it is. But it is also a moment of possibility.

When systems are in transition, there is space to rethink how things are done.

To move beyond language into practice. To align intent with execution. To build models that are more resilient, more equitable, and more sustainable.

That work will not happen overnight. And it will not happen perfectly.

But it will require leaders who are willing to engage with the complexity rather than simplify it away.

Leaders who are willing to make decisions, not just drive activity. Leaders who understand that the goal is not to deliver more but to build better.

The work of leadership
Much of this work is not visible.

It does not always show up in reports or metrics. It happens in how decisions are made. In what is prioritised. In what is deliberately left out.

It happens in the conversations that align partners. In the systems that are strengthened quietly over time. In the people who are mentored, empowered, and trusted to lead.

That is the work.

And increasingly, that is what leadership at this level requires.

Not more activity. But more clarity. Not more control. But better alignment. Not more presence. But more purpose.

About the author:

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Ota Akhigbe is the Director of Partnerships & Programs at eHealth Africa, where she leads multi-country partnerships, financing, and system-strengthening initiatives across public health and development. Her work focuses on aligning governments, donors, and private sector actors to deliver scalable, resilient health systems across Africa. She is deeply engaged in shaping the future of digital health, financing, and cross-sector collaboration on the continent.