Atlantic Fellows for Health Equity brings together health professionals from around the world and across disciplines to build leaders, combat disparities and create community. Its mission is to develop global leaders who not only understand the roots of health inequities but also have the skills and courage to create more equitable organizations and communities.

Each year, fellows share their reflections through Equity Talks — short presentations that highlight their leadership journey and learning during the fellowship. We are proud to bring some of these insights to the BMJ Leader Blog audience.

The blog below was written by Azua Wilfred, a 2024 Atlantic Fellow for Health Equity. 

To watch the recording of this talk, click here

A profound shift is underway in global health. Historically, the United States was a cornerstone of global public health funding. Recent adjustments in USAID’s budget and shifting priorities signal a new era in which African nations will increasingly need to strengthen their health systems. While foreign aid remains a critical pillar in global health, these shifts highlight the necessity of building sustainable, locally led models of care. Rather than seeing these changes as a challenge, we can view them as a catalyst for fostering greater resilience, ownership, and long-term impact within communities.

For those of us working at the intersection of medicine and community health, this moment calls for a reassessment of what truly drives sustainable health outcomes. It is not simply about external funding but the intrinsic values fueling grassroots transformation. My personal and professional journey, shaped by loss, crisis, and deep self-reflection, has reinforced one clear truth: health equity is not just about resources; it is about the leadership, trust, and shared purpose that sustain progress beyond any funding cycle.

Before joining the Atlantic Fellows for Health Equity, my approach to leadership was deeply individualistic. I equated excellence with hitting targets, optimizing performance, and pushing forward relentlessly. I worked with the belief that technical expertise alone could solve systemic health challenges. But over time, through both personal loss and professional challenges, I came to see the limitations of this mindset.

When I was promoted to oversee health programs across multiple districts for Reachout NGO, I applied the same performance-driven framework that had defined my early career. Reach Out Cameroon, established in 1996, is a Non-governmental organization that provides primary healthcare services, addresses gender-based violence, promotes economic security, and builds peace across Cameroon. I delegated responsibilities, trained supervisors, and expected results. But within months, the numbers told a different story: despite my technical capacity, motivation was dwindling, and the intervention struggled. I had to ask myself—why wasn’t this approach working?

I found my answer during my cohort’s mid-year convening in Rwanda. Despite facing similar financial and logistical constraints, their community health system was thriving. The difference? A deeply ingrained culture of intrinsic motivation. Their health workers were not merely executing tasks; they were bound by shared values, trust, and a sense of communal responsibility. Their work was not driven by external incentives alone but by an internalized commitment to their communities.

I returned home with a new perspective. Instead of focusing solely on performance metrics, I shifted my leadership approach to cultivate a shared sense of purpose. I worked with my team to build a culture centered on trust, dedication, and mutual accountability. Together, we defined our collective “North Star” a vision that transcended short-term targets and spoke to the deeper meaning of our work, and as these shared values took root, the data followed. Patient care improved, participation increased, and a true community of practice emerged. What I had once dismissed as intangible, the power of human connection and purpose became the most critical driver of sustainable impact.

One of the most transformative realizations during my fellowship was understanding the deeper meaning of investment. I had always equated impact with financial resources, how much funding was allocated, and how many projects were implemented. But through the lens of Chuck Feeney, the founder of Atlantic Philanthropies, I saw the most valuable investment is in people. Feeney, saw wealth not as an end but as a means to empower individuals who could, in turn, transform their communities.

This insight reshaped my understanding of sustainability in global health. Foreign aid is essential in supporting public health systems, but sustainable impact does not come solely from funding. Actual progress happens when local leaders are equipped with the skills, training, and autonomy to drive long-term change. External resources will always fluctuate, but leadership built on shared values endures.

Ubuntu, often translated as “I am because we are,” took on new meaning for me during my fellowship year. Initially, I interpreted it as a reflection of communal identity,  a recognition that our success is tied to those around us. But I have since come to see Ubuntu as a call to action. It is not just about existing within a community but about actively shaping it. Leadership, in this sense, is about multiplication. It is about ensuring that our values are not contained within us but embedded in those we lead.

This lesson is especially critical in the face of global shifts in health funding. As Africa navigates a future where self-reliance will be increasingly necessary, the success of our health systems will depend on whether we, as local leaders, can cultivate the next generation of changemakers. It is not just about advocating for continued investment; it is about ensuring that aid translates into strengthened structures, mindsets, and networks that make health equity a self-sustaining reality.

The adjustments in U.S. global health funding serve as a reminder of the importance of sustainability in health systems. Foreign aid has played an indispensable role in reducing disease burdens, expanding access to healthcare, and supporting frontline workers. Its continued presence remains crucial. However, these changes also highlight an opportunity, a chance to reimagine health equity as a movement driven by local leadership rather than dependence on external aid alone.

My journey from personal loss to professional growth, from individualism to collective leadership, mirrors this broader transition. Just as I had to unlearn my assumptions about success, we, as a global health community, must rethink what sustainability truly means. It is not about perpetual funding cycles but building ecosystems of leadership, trust, and shared purpose that endure beyond any funding source.

As we move into the future, we are entering a new chapter in global health, one in which innovative solutions will define the way forward. The question is not whether we can rise to the occasion, but, whether we will seize this moment to create systems that last. If there is one lesson I carry forward, it is this: the most profound change does not come from what we receive but from what we build together.

Author

Dr. Azua Wilfred is a medical doctor working with International Medical Corps as their regional program officer on emergency health and nutrition projects in vulnerable communities. He is a Senior Atlantic Fellow for Health Equity.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.