Unlearning the System I Spent 18 Years Strengthening

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This story was developed with the support of AI to help organise, refine, and strengthen the writing. The experiences, reflections, perspectives and original ideas shared in the story are my own. AI was used as a writing and editing aid; the voice, meaning and substance of the story remain mine.

The Genesis of It All

I started my development journey at 19, as a clinical officer with Watoto Child Care Ministries.

It was more than a first job for me. Watoto was my church, a place that had nurtured me spiritually, and I was deeply excited about the opportunity to give back in whatever way I could. I was appointed as a village doctor, serving communities of children and women who had experienced profound disadvantage.

I remember the joy of that appointment.

I felt that I had found my purpose: to serve.

Three years later, one night changed the way I understood that purpose.

It was around 2:00 a.m. when I heard a loud knock at my door. I was living in the clinic staff quarters, close to the health centre. At the door were mothers carrying a seven-year-old girl I knew from the clinic and had grown particularly fond of.

She was in severe respiratory distress.

We rushed her into the ambulance and started oxygen therapy. But despite everything we could do, she died minutes later in my arms.

I have rarely experienced anything as devastating.

For weeks afterwards, I struggled to sleep. I kept replaying the night in my mind and asking myself whether I could have done something differently.

Eventually, I sought a few therapy sessions. But beyond the grief, something else had shifted in me.

I began asking a much bigger question:

What happens when the problem is bigger than the person standing at the bedside trying to solve it?

I realised that I could treat one patient at a time, but there were structural conditions shaping whether people reached care, whether care was available when they arrived, and whether the health system could respond effectively.

I wanted to do more than respond to the consequences.

I wanted to understand and change the conditions producing them.

That was the beginning of my transition from clinical practice into public health.

From the Household to the Health System

For the next several years, I worked primarily in community health, focusing on health promotion and disease prevention.

My work took me directly into communities and households, working alongside community health workers and primary healthcare facilities on maternal and child health, nutrition, HIV/AIDS, WASH and other public health priorities.

I had the privilege of working with organisations including World Vision, JHPIEGO, and ChildFund.

The agenda was often similar: improve health knowledge, increase access to services, strengthen community engagement and ultimately improve health outcomes.

And I believed strongly in that work.

But over time, another lesson became increasingly difficult to ignore.

Health education cannot compensate for a health system that does not function effectively.

You can teach a mother when to seek antenatal care, but what happens when she arrives at a facility and there is no skilled provider?

You can mobilise a community to seek services, but what happens when medicines are unavailable?

You can increase demand for maternal services, but what happens when the facility cannot provide safe emergency care?

I began to see that the work could not stop at the community. We had to strengthen the system around the community.

That led me deeper into health systems strengthening, working directly with CARE, JHPIEGO, AMREF, and CORDAID

I became involved in efforts to improve health infrastructure and services, including supporting the refurbishment and functionalisation of eight neonatal intensive care units, including the national referral point.

Again, I was learning to think beyond the immediate intervention.

Then Came Health Financing

My transition into health financing came from another question that had been growing in my mind.

I had spent years watching development partners and governments invest significant resources into health programmes. But I became increasingly curious about something:

How effective are the approaches we are investing in, and how do we get the greatest possible value from scarce resources?

I became particularly interested in how health workers and health facilities respond to incentives, how resources flow through health systems, and how financing could be designed to improve both performance and access.

This led me into results-based financing. I went on to contribute to and lead the scale-up of results-based financing in Uganda, working at the intersection of financing, performance, data, and health systems.

It was an important chapter in my professional journey; I learned about economic evaluation, incentives, accountability, purchasing, and the enormous complexity involved in trying to change how systems behave.

I also learned something else.

Financing is never just technical.

Money shapes behaviour.

The way money is allocated determines what gets prioritised.

The indicators we choose determine what becomes visible.

The things we measure can become the things organisations chase.

And the people who control resources inevitably influence the direction of the system.

At the time, I was primarily thinking about how to make these mechanisms work better. I did not yet have the language I have today for questioning the architecture of power behind them.

But the questions were beginning to emerge.

The More I Worked Within Systems, the More I Saw the System

Over 18 years, my work expanded across the humanitarian and development ecosystem.

I worked across medical practice, community health, health systems strengthening, health financing, policy, digital systems and large-scale programmes.

• I worked alongside communities, health workers, governments, development partners and funders.

• I supported policy reviews.

• I contributed to the scale-up of digital systems.

• I worked on maternal and neonatal health.

• I worked on financing and performance.

• I worked on advancing Locally-led development 

And throughout this journey, I kept trying to answer the same fundamental question:

How do we make development interventions work better?

But eventually, the question itself began to change.

I started asking:

• Who decides what "better" looks like?

• Who defines the problem?

• Whose evidence counts?

• Who controls the resources?

• Who gets to determine the priorities?

• Who carries the risk when something fails?

• Who gets recognised as an expert?

• And why do some organisations consistently get to make decisions while others are expected to implement them?

These questions made me uncomfortable because they were no longer questions about programmes. They were questions about power.

What If We Are Strengthening the Wrong Things?

The more I worked within development systems, the more I began to notice a paradox.

• We can strengthen a health facility without changing who gets to decide what that facility needs.

• We can build the capacity of a local organisation without asking why its existing capacity was not recognised.

• We can fund a community-based organisation while retaining control over the decisions that matter most.

• We can introduce digital systems without asking who owns the data, who controls the technology and whose knowledge is embedded in the system.

• We can talk about localisation while many of the most consequential decisions remain elsewhere.

• And we can call organisations "partners" while one side holds the money, sets the rules, defines the outcomes and determines what counts as success.

This is where my own unlearning began.

Not because everything I had done before was wrong. It wasn't;  Much of it mattered enormously. People's lives improved. Systems became stronger. Services expanded. Resources were mobilised. But I began to understand that good programmes can still sit inside unequal systems.

And that is a much harder problem to solve.

What happens when we become very good at strengthening a system without questioning the assumptions that built the system in the first place?

The Limits of Good Intentions

One of the hardest things I have had to confront is that good intentions are not enough. Most of the people I have worked with genuinely want to make a difference; I have certainly wanted to make a difference. But good intentions can coexist with unequal relationships. We can care deeply about communities while still producing bad outcomes.

This is not simply about individual people behaving badly; it is about systems that have normalised particular ways of working. Systems that have taught us who is expected to lead, who is expected to implement, who is expected to fund, and who is expected to receive.

That is why I have become increasingly interested in unlearning.

Unlearning Is Not About Rejecting Everything

For me, unlearning does not mean throwing away 18 years of experience; it means examining it more honestly. It means asking what I learned, where those lessons came from, what assumptions were embedded in them, and which of those assumptions I still carry.

It means recognising that I, too, have participated in systems I now want to change. I have written proposals, managed programmes, worked with funders, made decisions that affected others, and benefited from the structures of the development system. So I cannot position myself outside the system and simply critique it.

I am part of the system I am trying to reimagine.

That, for me, is where decolonial practice becomes more than a concept. It becomes personal.

Why PRA Exists

This is part of what led me to establish and steward the Philanthropy Reform Alliance (PRA). https://philanthropyreformalliance.org/

PRA grew out of a conviction that we need spaces where development practitioners can stop, reflect, and question the assumptions that have become normalised in our work- a space for collective unlearning.

A space to ask difficult questions about power, partnership, philanthropy, knowledge, risk and resources.

A space where funders, international organisations, community-based organisations and development practitioners can examine not only what we do, but how we have come to believe that it is the right way to do it.

For me, PRA is an extension of the journey I started at 19.

The questions have simply become bigger.

And now I find myself asking:

How do we create development systems in which the people closest to the issues have greater power to shape the solutions?

From Giving To, to Building With

This question naturally brings me to philanthropy.

I have come to understand that money is never simply money. Money carries power.

Who controls it matters.

Who decides where it goes matters.

What conditions accompany it matters.

Who is trusted to use it matters.

And what happens when something does not go according to plan matters.

If we want locally led development, it is not enough to ask whether money reaches local organisations.

We have to ask:

Who decides?

Who sets the priorities?

Who defines success?

Who determines risk?

Who decides what is credible?

And who has the freedom to change direction when the original plan no longer makes sense?

That is where I believe philanthropy has an enormous opportunity.

To move from giving to communities towards building with communities.

From control towards stewardship.

From transactions towards relationships.

From funding projects towards resourcing people and movements.

From assuming risk must be managed by those with money towards recognising that those closest to the work often understand risk differently, and sometimes better.

What I Am Still Unlearning

I don't claim to have figured this out. In fact, PRA has made me increasingly comfortable with not having all the answers. I am still unlearning and questioning assumptions I have carried for years. I am still examining where I have reproduced the very practices I now critique, and I think that honesty is important. Because decolonizing aid cannot simply become another set of language we use while continuing to behave in the same ways.

It has to change how we relate, decide, fund, listen, share power, understand expertise, and perhaps most importantly, how comfortable we are with not being the one in control.

What 18 Years Have Taught Me

Looking back, these are some of the lessons I carry with me:

• Technical solutions alone cannot solve problems.

• Health systems do not exist separately from the social, political, and economic systems around them.

• Localisation is not simply about moving implementation closer to communities; it is about moving decision-making.

• Partnership without shared power can remain dependency in different language.

• Money is a tool, but control over money is power.

• Trust is not the absence of accountability; it is a different way of understanding accountability.

• Data and evidence are not neutral when the systems producing them are not neutral.

• Good intentions do not automatically produce equitable outcomes.

• Unlearning is not about abandoning what we know; it is about becoming willing to question what we thought we knew.

I Am Still Learning

After 18 years in development and humanitarian practice, I find myself less interested in having all the answers.

I am more interested in asking better questions.

The journey that began with a 19-year-old clinical officer wanting to save lives has taken me through communities, health facilities, government systems, financing mechanisms, policy processes and development programmes.

It has taught me how to strengthen systems, but it has also taught me to question them.

Today, through PRA, I am interested in what becomes possible when we stop assuming that the systems we inherited are the only systems we can build.

Perhaps this is the next chapter of my journey.

Not stepping outside the system and pretending I have all the answers.

But staying close enough to it to understand it, and becoming brave enough to question what I once helped strengthen.