Equity, Leadership, and Global Health Impact: Dr. Bertha Simwaka in Conversation

In this episode of LSTM In Conversation, Professor Sally Theobald reconnects with LSTM alumna Dr. Bertha Simwaka, now Senior Fund Portfolio Manager for Zambia at the Global Fund. Together, they explore Bertha’s career journey from her PhD at LSTM, embedded in Malawi’s health systems, to leading multi-million dollar HIV, TB, and malaria programmes across Zambia and India.

Bertha shares her reflections on the importance of gender equity, multidisciplinary approaches, and the role of community health in strengthening national systems. She offers practical insights into navigating leadership in global health, balancing international responsibilities with personal commitments, and ensuring health programmes are both impactful and sustainable.

This inspiring conversation also includes advice for early-career professionals on embracing collaboration, valuing local expertise, and building careers that drive real-world change.

Transcript

Unknown: 0:08

So hi everyone. I'm Professor Sally Theobald. I'm a Chair in Social Science and International Health here at Liverpool School of Tropical Medicine. And it's a real pleasure to be hosting this LSTM in conversation podcast with our brilliant guest, Doctor Bertha Nhlema Simwaka. So Bertha's an LSTM alumna. She graduated with her PhD in 2007 and I was one of her supervisors. And Bertha and I also I had the privilege of working with Bertha and other brilliant colleagues in reach trust in Malawi between 2004 and 2006 for me and Bertha has had a brilliant career spanning 20 years, and is senior fund portfolio manager for Zambia at the Global Fund. So Bertha, it's really wonderful to have you with us today. I'm really genuinely looking forward to discussing and catching up and hearing your experiences, Bertha. Can I just start by asking you to tell us about your experiences of doing a PhD at the Liverpool School of Tropical Medicine and the impact that that's had on your career. First of all, I just want to thank you as Professor Sally and team for giving me this opportunity. I really miss the community, and I think this is a way of connecting with the community, and I'm so excited about that. I hope we can have even more interactions in in future. So just reflecting on the my journey in terms of my PhD, so I think you have already mentioned that I graduated in 2007 and I was so lucky that, you know, my PhD was nested in a program that was already, you know, running it was a collaborative Consortium. It was a consortium between the Liverpool School of Tropical Medicine, the University of Malawi, and the Minister of Health. And specifically, of course, we're working with a Community Health Sciences unit, which now, in fact, it has transitioned, is a Public Health Institute in Malawi, kind of like a, you know, a national arm for health security in Malawi. So basically, I think I say it was an opportunity for me, because I think it gave me, you know, an opportunity to explore, like, what path do I want to take in my career life? And I want to say that one unique issue that I think when I speak to other people, comparing my experience with LSTM and other universities like LSTM, I think it gave me a real time experience of what international health, global health and public health is, and also, you know, like a space, like field laboratory, in terms of how applying, you know, multidisciplinary skills. And it was at a time when the concept of gender health and equity were just becoming prominent within the health sector in Malawi and also at global level, I remember we had to discuss quite a lot in terms of, okay, how do we frame equity in a way that the biomedical expert clinicians can understand it? So I think it gave me a live kind of laboratory in terms of, you know, understanding international health. I think also, STM community is unique in that, I think the passion about, you know, like building knowledge that is so applicable and practical in the context of, you know, developing countries, in the context where you know you are still building the health system so that experience you can, of course, hone your academic skills at the same time. Also, you know, have an environment in terms of academic environment that looks towards, you know, creating solutions, practical solutions, innovations in terms of how health services can be implemented in a way that it makes sense, especially, you know, in a context where There are gender related challenges, cultural and also geographical challenges, and then also, you know, having that community that is so passionate without compromising in terms of the quality of new technologies for health, you know, bringing in the aspect of, how do we reach the poor of the poorest, how do we women? So that was a very exciting component, and I would say that it laid a strong foundation for what I'm doing now at a global fund, and also what I've been doing in with other entities. Thank you. Yeah, that's really great to hear. We're really proud you're our alumna, and really nice to hear about the focus on context of embedded learning on it, multidisciplinarity. And as you said, you know, gender equity pro poor approaches. How do you make them real and accessible and also focus on problem solving and impact? So thank you very much for those reflections. And I wondered if you could tell us a little bit about what happened next. So your journey to your current role as senior fund manager for Zambia at the Global Fund, yeah? So, of course, I mean, after graduating, I had some, you know, some years working also with within the consortium of Reach Trust, yeah. And then, of course, I decided just to explore, you know, us, in terms of directly working with the program. So I spent some three years in Zambia working mainly with the malaria programs, with a path which was implementing a Gates funded programs. I joined Global Fund in 2013 initial as an evaluation and impact expert, and then of I moved on to Grand management division. Why I moved on to Grand my management division is because it's kind of like the face of global fund to the countries, and it gives an opportunity in terms of shaping programs investment. And therefore, you know, thinking all those, you know, skills that I gained at the Liverpool School of Tropical Medicine. And maybe, for those who don't know Global Fund, maybe it's an opportunity just to say, what is global fund? So it is. It is a partnership. Is a public, private partnership that draws together, you know, civil society organization, governments and private sector to mobilize the sources. Of course, it was created, you know, by a team of elders, including Kofi Annan, back in the years 2002 with a purpose of mobilizing resources for HIV, TB and Malaria. But of course, now, I mean, we also look at issues of, you know, strengthening health systems pandemic preparedness, and also mainstreaming gender human rights issues in the programs. So just that snapshot of our global fund, and then in terms of where I am now. So I mentioned that I started as a valuation impact specialist, then I moved to grant management, which is kind of like the face of global fund with the countries. And my first role was a public health and monitoring evaluation expert, which is basically, you work with different portfolios, you know, looking at issues of programming and then also ensuring that the investment is strong, and also you have built in the concept of, you know, understanding the impact. Because, you know, performance is very important for Global Fund. Results are important because they are the ones that define in terms of resource mobilization and advocacy. So I spent almost five years in that role. And then, of course, there was an opportunity. I moved on as a disease fund manager, which kind of like fund portfolio manager, but I was only focusing on HIV, and I did that for four years working with India, the Indian government, in terms of the National AIDS Control organization in India, and also non government organizations that were like, implementers of programs that we fund in India. And then after that, of course, I got an opportunity. You know, it's almost two years now that I've been working as a senior fund portfolio manager for Zambia. In Zambia, the portfolio that I'm overseeing right now is around, I think, three, 60 million US dollars, and we are funding TB, HIV and malaria programs. We also work with Zambia National Public Health Institute, which is like, you know, an entity like the like, like Africa, CDC at national level. And they are the ones that have the mandate to coordinate, like respond to epidemics, to outbreaks, and also like the issues of surveillance, you know, rolling out surveillance. So we work with them and support their strategy in terms of rolling out this surveillance system, but also effectively responding to outbreaks. And then, of course, we also work a lot in terms of supporting the country building strong systems for health. And one of the of portfolios in the system strengthening is community system strengthening in Zambia, where we're working with the Minister of Health to kind of like, you know, create a strong policy environment for working with community based volunteers across all diseases and then also empowering them in terms of capacity building with tools. And also, you know, systematic issues like supervision to ensure that quality of services. But also they're equally motivated. Yeah, so I think basically, I would say my role as a fund portfolio manager is like, you know, providing leadership and oversight for the portfolio. I imagine it must be really good to be working in a country and context that, you know. Well, you said that you were in Zambia post your PhD for a while, and you've talked about the leadership role that it entails, and the number of different stakeholders that you work with focus on community health strengthening, as well as broader health system strengthening. So I wondered if you could tell us a little bit about what advice you'd have for others from that process and from your leadership role? Yes. So I think what I would say, especially for the young, maybe our fellow young colleagues that have the ambition to work in global health or international health, I would say that you know, whatever you're doing now will kind of like shape your life. So every opportunity that you have, whether it's, I mean, courage at LSTM or you're doing your thesis, every opportunity that you have is a pathway to where you want to be. And then also in terms of leadership, leadership is not a matter of position. Leadership is how you pursue your goals and how you work with others, in terms of, you know, building their support towards a goal that you are convinced that is the right mission, for community, for yourself, for others, and it's basically whatever you're doing now. And also, I think the issue of, you know, finding value in my disciplinary these days is very important, especially for those that are, you know, have the ambition to grow their career in international health. I mean, of course, we know that. I mean, we all have our own backgrounds, but for you to be successful, you have to embrace the role of different, you know, disciplines, whether it's clinicians, you know, other discipline like community prayers, I spoke about community based volunteers, these are, you know, people that just community members who find it like a joy in terms of serving others. So it's embracing the discretionality of health that will help you also in terms of to work in future, whether it's at a global level or at national level, because we cannot talk of international health without really talking about the disciplinary nature of health, and also multicultural, you know, nature of the ecosystem that we deal with. And then, of course, learning is not just in class. As I mentioned earlier on, I had the opportunity of doing my PhD that was nested in the program. You might not have that opportunity, but there are so many opportunities that you can also explore. For example, maybe during your you know, when you have semester break, taking a volunteer, you know, role somewhere there is that opportunity, I would encourage you to do that, and also, kind of like reaching out to alumni that had been at LSTM, like myself, I'm free to take and to encourage, but also to support in terms of what path you would Want to do because, you know, we are a community, and we we have to nurture and support each other, and then also we have to connect, because connection is very important, learning how to connect with different disciplines, learning how to connect with, you know, with other prayers that you might not really agree in terms of some principles, but finding entry points that you can leverage you know your knowledge, and also you know the areas where you have commonalities, that's brilliant. And thank you for also offering support and advice. I know that people would really benefit from that, and I really like the idea, you know, we all have the opportunity to be leaders. It's not about position. It's about how we work together, how we build connections, how we build those ideas of supporting, cultures of mutual support and understanding, and driving forward and transdisciplinarity and seizing opportunities when they come Yes. So yeah, thank you for that brilliant advice. And I wonder if we could take you back to your current role, and whether you could give us some examples of a particular part of the portfolio in Zambia that has really had positive health outcomes for equity. So I would say that, of course, you know, there are several prayers in Zambia. Global Fund is one of them. We also have, you know, USA funded programs like PEPFAR and others, and also the government itself. I would like to mention that I think the. HIV program has brought in a lot of results in terms of, like, value for money, when, when all these investments were coming in. You know, there was even a saying that, you know, the coffin industry, it kind of like boomed because of the the number of deaths, or mortality related to AIDS. But with the coming in of all these health financing mechanism, including global fund, we can say that at least that has been reversed. And then, of course, we still have a fight. But in terms of also the new infections for HIV, we'll see that, you know, they have gone down. Of course, there's still a lot of work, especially among the adolescent girls and young, you know, women, and also what we call the key populations. In the context of key populations, it's like female sex workers, you know, MSM, and also people that use, like drugs Id use, you know, there's still work to do. But I think one of the successful stories is that you know the role of communities in highlighting the importance of these groups, the importance that we cannot, you know, reach the final target of making HIV not as a public health threat, if we don't reach these key populations, even in India, African context, especially the in the context of Zambia, the young people, they are still like the highest you know, affected. So that is one of the areas that we have seen results and impact scaling up of treatment and also reversing the trend of mortality and new HIV infections. There are also other areas, you know, because of this investment we've seen, like the strengthening of laboratory networks, initially it was so difficult to move, like, to transport sample from one point to another, but through collaboration and partnership, you know, there's strong like Hub and Spoke networks that that ensures that, you know, services reach everybody, including, you know, women and also key populations, because you cannot reach them if they don't have access to diagnosis and also treatment. So that's one of them. And then, of course, that brings in the issue of, you know, in general, all these systems, of course, initially the focus was to bring services for TB, HIV and malaria, but they have had spill over impact, positive impact on the national response. Like recently, you know, Zambia had a very, you know, catastrophic cholera outbreak due to climatic issues, but they were able to reverse and respond effectively because of the strong community system network, strong surveillance network and strong laboratory network. So this helped them to to detect airy and also to to know where they have hot spots and and then respond effectively. So there are so many positives, but the work is still there. Yeah, thank you, Bertha, it's really insightful example. And the focus on different groups that experience multiple vulnerable multiple vulnerabilities, and the need for lab system strengthening and working with communities at every part of the journey. And I like the way you've explained how system strengthening has positive repercussions beyond HIV, TB and Malaria, and that's really inspiring in terms of the cholera response. So thank you for those so just how does it work, then, for you and your daily role, how much time do you spend in Geneva? How much time do you spend traveling to Zambia and other contexts? What does it feel like on a day to day basis to be a international, global health expert? Yeah, so, okay, of course, I want to say it's not, it's not easy. It's complex because, you know, I have children, because there's some, I mean, some young women will say, Will I manage with my family? And also, you know, traveling? So I think from that angle, I would say it's like one of the areas that worked well for me. It's also, you know, beside work is also building a strong social you know, support system for yourself is very important, especially when you have a family and children. So in terms of the work, basically, I travel between 30 to 40, you know, percent of time, like once every quarter, I have to go to Zambia with, with a team that works on the country, to just, you know, follow up with a country. Also undertake, you know, politics. It's all politics. Health is also politics. You know, without the politics, you know, we can't move forward. Of course, positive politics for health, not not negative politics, coordinating with all the partners from governance perspective, and then also monitoring that the. Programs you know are running well, in case, maybe there are issues, you know, it these type of missions. They help us also to unpack those issues and then respond effectively. So it's kind of like that. And then sometimes it can be more, depending on the you know what, what is going on, the dynamics at country level. So I would say that, in fact, I enjoy most of the time in the during the missions in country, because we learn a lot from from from the from the prayers in country, prayers the civil society, the government, and also, you know, other players. One thing I want to also mention is, like, I think over the years, I've learned is an issue of listening to the country is very important, because most of the times, for the challenges that we face in our work, the solutions are there. They know the solutions. And sometimes it's just a matter of encouraging them, like inspiring them to, you know, to move forward and, know, implement. I think this has been a learning curve for me and the other and this is not just unique to Africa, because I also worked in on India for most four years. Solutions are usually in country, the community members, they have the solutions and the prayers. In the government cycle, in the civil society, they have the solutions. But sometimes it's just you know, convening. You know that aspect of convening so that there's, you know, a conversation, having positive conversations around issues, so that you know you can, you can, you can collectively address issues, yeah, yeah, Bertha that's brilliant, and I think, really lovely insights about leadership, about listening, convening, inspiring, encouraging, and that the solutions are within the context that we work with. And being part and parcel, and partnership there and health is certainly political, and the personal is also political, and I like the way you reflected on your personal journey and what it means to be a mother working in international health and the need to build up strong strategic support networks too. So thank you very much for those reflections. And I think what we'd love to hear more of as well, from your embedded position in this international level working with national portfolios, is where you see future trajectories in international health, where, what, what do you think the key issues and key challenges are, if you had a crystal ball, what? What would you say? That's, that's, that's a very important question. But I'm not sure if I have answers for that. I'll just say, I think, I think all of us have been on a journey. When I say, I mean, all of us, I think, within the ecosystem, like different players, that's, you know, like healthy financing, you know, mechanisms, agencies, and also the countries, civil society, everyone we've been on the journey. And I think now the space is like, okay, there's that opportunity to reflect in terms of, okay, how best do we work? Because there was a point in time where we would say, maybe Okay, the issues of capacity. Of course, we still have to deal with those issues at country level in a different way. But, you know, the countries also have grown so much in terms of, if you if there's a cycle of, you know, capacity, in terms of health system, I think there have been quite a very positive, you know, growth in the country in how, you know, they also manage the negotiations with with the international entities, and then also defining the programs and response. You know, of course, we still need to build the human resources for health and others, but I guess we are at a time when we all have to look at like we reflect in terms of, where do we focus more in future? Do we focus more in the way we've been working in the past? Like, okay, specific areas, or we take more, kind of, like, a comprehensive approach and maybe ttailor made solutions for each and every country. And then also, I think there should be also an acknowledgement in terms of, of course, there are domestic financing challenges, but there's quite a lot of goodwill or willingness from the countries to build their own, you know, resources internally to beef up the response for different issues that the countries are facing. The question is like, how best then do we leverage the additional resources? So it's a it's a complex stage. We are at a complex stage that I think we all have to, like, maybe honestly reflect on. I. And I think that would define whether we will be like the level of impact that we've had in the past will continue or not, how we move forward from now onwards, in terms of how we work together at international level, like the the the Research Institute, the financing organization and also other implementers, and then also appreciating the in country, already existing capacities, that that is already there. I think the bigger issue is like, Okay, if we make a shift, then how do we sustain the gains that have already been made? I think there's that huge risk that all of us, I think we really need to acknowledge, including the countries like, how do we how do we manage that we don't lose the least, I mean, the gains that were made if we make any type of transition that we want to make. Do we have investment in sustaining those gains? And then what we need to ensure that we are sustaining at the same time we are also maybe, you know, moving towards, you know, like transitioning and all those things. Yeah, very interesting reflections. Bertha, thank you for sharing. And you know, LSTM is 125 years old now. Yeah, congratulations. So we're also going through a process of reflection around our role in 2024 and how to make ourselves fit for purpose and with a decolonizing lens and the partnerships that we bring. So it's interesting to hear you reflect too on sustainability and transitions. So I guess Are there any other thoughts that you have for our fellow alumni, LSTM community, current and past students, any further thoughts or reflections or advice you know, you've had this incredible career, and of course, it's ongoing, the embedment in Malawi, the PhD, the work in the different knowledge programs, work in Zambia, and then all these different roles within the Global Fund, but with a particular focus on India and on Zambia. Any further advice, thoughts or reflections for the LSTM. Big community, big, as in all of us that are here or have been here or links with LSTM in any way. What I want to say is, what first is what I said earlier on. I mean, LSTM has a very unique model in terms of how you you work, you are building critical mass for global health in different disciplines at the same time. I think I mean you have very strong networks and relationship with the Global South, which is very important. And also the approach is very unique in that I think there's the value for for, for, not for knowledge transition from knowledge generation to transitioning it to, you know, tools that you know the governments or players can use. I think that that approach is still relevant, even now. It's important. And I want to also say that the issue of operational research, which is kind of like, now we call it implementation science, but it's the same thing. It is still varied. Now it's still, every time when you interact with with players, there's always a question like, Okay, how do we how do we do this in a way that is acceptable, it's feasible. So implementation science is still critical. Of course, we still have to develop new tools for vector control, which LSTM of impact has been very, you know, I should say they have been. They have played a very critical role. I mean, the LSTM affiliated consortiums in terms of, you know, building new, for example, vector control tools for malaria response and other, you know, diseases, it's important. But I think the implementation says, Let's not lose our sight. Let's not lose our sight on it is still important, because for the tools that are developed, for them to be useful, to bring the results that we see, we have to understand how to implement and how to reach everyone, because that's the most important thing that I think sometimes it's not easy to acknowledge because it looks simple, but it's also very complex. How do we make sure that everybody is in from gender perspective, and all other you know, areas that you know affect access to health. Well. Thank you so much Bertha for those reflections, and we really appreciate you taking time out of your very busy schedule to join with us and to share your journey and the learning that's come. From it, and for me, I've heard a lot about what leadership means in terms of focusing on partnership, listening, inclusivity, that strong focus on gender and equity. I've heard a lot around the focus on sustainability, and how do we build partnerships that have sustainable impact? And I think the laboratory strengthening examples and the community partnership were very strong there. And I think you've given lots of fantastic advice to people at different stages in their career about seizing opportunities, building networks, being collaborative, taking the strengths from different disciplines and different methods to really unpack and understand situations. And we really appreciate your offer of support and networks and that people can reach out to you. So for me, it's been really wonderful to reconnect after too many years, and you know really proud that you're our alumni, and proud of everything that you've achieved, and look forward to staying in touch and hearing what comes next too. So many thanks Bertha for sharing, and we've learned a huge amount from you. Thank you. Thank you very much, Sally, for your time. I hope we can I hope. I'm looking forward to coming to Liverpool, just to come we'd love to invite you, and we'll make that happen. Yeah. Thank you.