One year after Oxford: reflecting on systems, leadership, and complexity in global health
Medical doctor and public health leader Abdihamid I. Ahmed reflects on his experience in Oxford on the Msc in Global Healthcare Leadership programme and how it has impacted his approach to work and capacity to sit with complexity.
About the author: Abdihamid I. Ahmed is a medical doctor and public health leader with over 17 years of experience in health systems strengthening and emergency preparedness across Africa and the Middle East. He holds an MD, an MBA and is a recent alumnus from Cohort 1 of the MSc in Global Healthcare Leadership at the University of Oxford. He currently works with UNICEF Headquarters on Primary Health Care and health systems strengthening.
It is now nearly one year since I graduated from the University of Oxford on 31 May 2025 with an MSc in Global Healthcare Leadership (MGHL). As I approach this milestone, I find myself reflecting less on the degree itself and more on the subtle but lasting shift it has created in how I see the world. I did not leave Oxford with definitive answers. If anything, I left with a greater capacity to sit with complexity, particularly within health systems that operate under constant pressure.
Returning to work across health systems in Africa and the Middle East, I have found myself in familiar environments that now feel subtly different. The challenges themselves have not changed, but the questions I ask have. I am less drawn to immediate solutions, and more attentive to how systems behave, adapt, and sometimes resist change. Leadership, in this sense, has become less about direction and more about understanding the forces that shape outcomes.
Neha, Nargis, and Abdihamid during the MHGL graduation ceremony at the Sheldonian Theatre, University of Oxford, May 2025.
Why I took the MSc in Global Healthcare at Oxford
After more than 15 years working across Ministers of Health, World Health Organization (WHO), UNICEF, the private sector, academia, Non-Governmental Organizations (NGOs), and other institutions, I reached a point where I needed to pause and reflect more deliberately on practice.
Much of my work had been shaped by urgency - responding to immediate needs, supporting implementation, and navigating constraints in real time. Over time, I began to notice a recurring pattern: even when technical solutions were clear, embedding and sustaining them within real-world systems was far more complex than anticipated.
Alongside this professional reflection, there was also a more personal dimension. Studying at Oxford had been a longstanding aspiration - a childhood dream shaped more by what the institution represented than by any clearly defined path. In many ways, pursuing the MSc came at the intersection of that early ambition and a later need in my career to step back and think more deeply.
The MSc in Global Healthcare Leadership at Oxford offered the space to do both. What I encountered on the program was not a single framework, but multiple ways of understanding health systems, leadership and complexity. Equally important was the diversity of perspectives, many of which challenged assumptions I had not previously questioned.
Rethinking leadership in complexity
One of the most significant shifts has been in how I now understand leadership. Earlier in my career, leadership often felt tied to roles, authority and decision-making. Over time and particularly after Oxford, I have come to see it differently. In complex health systems, leadership is less about control and more about interpretation and alignment.
It involves working within systems that do not behave predictably, alongside colleagues who operate under different incentives and constraints. It also requires accepting that progress is rarely linear, and that influence is often gradual and not immediately visible.
This shift has changed how I approach my work. I now pay closer attention to questions that rarely appear in formal plans but shape outcomes in practice: what builds trust between colleagues? Where does misalignment emerge between policy and implementation? Which relationships quietly determine whether systems function or stall?
Leadership, in this sense, has become less about directing systems, and more about listening to them.
Abdihamid visiting the Oxford Global Leadership Centre during one of the MHGL programme modules in 2023.
A small moment that stayed with me
Not long after returning from Oxford, I was in a meeting with colleagues discussing how to strengthen community health service delivery in a resource-constrained setting. The conversation quickly moved, as it often does, to solutions: new structures, revised guidelines, additional inputs.
At one point, the discussion paused as a local health worker described the reality on the ground: multiple reporting lines, overlapping programs and limited clarity on priorities. What stood out was not the absence of technical knowledge, but the quiet misalignment between what was planned and what was experienced.
A few years earlier, I might have focused immediately on how to refine the plan. This time, I found myself asking a different question: where exactly is the system not aligning and why?
It was a small shift, but a meaningful one. Rather than asking how to fix the system, I was trying to understand how it was functioning in practice.
From theory to practice
Returning to practice has been a grounding experience. Health systems in fragile and resource-constrained settings do not operate in neat sequences. They are shaped by competing priorities, shifting resources and constant adaptation.
In such environments, the most important work is often not introducing new ideas, but strengthening what already exists and enabling it to function more coherently.
In my work on primary health care and health systems, I now see systems less as separate components and more as lived ecosystems. Community services, facility-based care and vertical programs are not parallel structures; they are interconnected in how people actually experience care.
This has changed how I think about design and implementation. It is less about creating ideal models, and more about building systems that can operate under real-world constraints while remaining responsive to people’s needs.
Shawn Mathis, Abdihamid I Ahmed, and Gurpreet Singh on the rooftop of the Saïd Business School building during Module 6.
Context, fragility and lived experience
Being born and raised in Somalia, a conflict-affected setting, has shaped how I understand health systems in ways that go beyond professional training. Fragility, for me, is not an abstract concept. It is a lived reality in which systems are continuously tested.
On the MGHL program, this perspective became more clearly articulated. I was better able to express something I had long observed: that in fragile settings, formal systems alone are never sufficient. Informal networks, relationships, and trust often determine whether services ultimately reach people.
This has reinforced the importance of grounding global health discussions in lived realities. Context is not something that can be managed from the outside; it is the environment within which systems either function or fail.
One year on: what stays with me
A year after the MGHL program, I find myself less focused on defining achievements and more attentive to how my thinking continues to evolve.
Three reflections, in particular, stay with me:
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Systems change is rarely visible while it is happening; it becomes clear only in retrospect.
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Leadership is fundamentally relational shaped by trust, communication and the ability to work across boundaries.
Complexity is not a problem to be solved, but a reality to be understood and engaged with more thoughtfully. If I were to summarize this past year, it would not be in terms of milestones, but in terms of perspective. The course at Oxford did not distance me from the realities of health systems; it provided a different way of returning to them.
The work ahead, strengthening primary health care, supporting community systems and advancing equity in health outcomes remain unchanged in purpose. What has shifted is how I see the systems in which this work takes place, and the questions I now bring to it.
In many ways, the most meaningful change has been subtle: not what I do, but how I see.
And perhaps that is the most lasting lesson of all.
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