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There’s a striking paradox at the heart of global healthcare: the people who do most of the work have the least say in how it’s run. Nurses and nurse midwives comprise roughly 80% of the health workforce in low- and middle-income countries — and yet, as one landmark report put it, the sector is “delivered by women, led by men.”
Julia Bluestone knows this dynamic firsthand. As Technical Director of Learning and Performance at Jhpiego, a Johns Hopkins-affiliated global health nonprofit, she has spent 25 years working across more than 30 countries to strengthen health systems from the inside out. She’s also a nurse-midwife herself — and a former WTCI Bowe Fellow.
That last credential matters more than it might seem.
A Fellow Who Became a Program Architect
When Jhpiego’s then-president Leslie Mancuso encouraged Bluestone to apply for the Bowe Fellowship, she was a team lead who, by her own admission, was “really good at getting things done” but wanted to develop as a strategic thinker. The fellowship was exactly what she needed. She came away with frameworks for vision and strategy, sharper skills in negotiation and change management, and something harder to quantify: a renewed sense of how your perception of yourself shapes how you show up in the world.
She didn’t leave that in a binder somewhere. When Jhpiego developed its nurse leadership program in Kenya, Bluestone drew directly on her Bowe Fellowship experience to shape the program’s design. The program’s emphasis on external mentors — specifically women who had completed robust leadership programs themselves — mirrors what she found most valuable as a Fellow. The goal of helping participants “take their space and use their voice without waiting for permission” aligns almost directly with her own fellowship takeaways.
In other words, she didn’t just benefit from leadership development. She turned it into a replicable model.
The Gap the Program Is Built to Fill
The nurse leadership program in Kenya targets early-career nurses and nurse-midwives. Burnout rates among Kenyan health workers run as high as 35%, and attrition is steepest among those earliest in their careers. Meanwhile, a 2025 State of the World’s Nursing Report found that only 25% of low- and middle-income countries reported having any formal leadership development opportunities for nurses.
Existing leadership programs tend to focus on executives. Jhpiego went the other direction.
Over four months, a cohort of 24 nurses and nurse-midwives moved through a blended program: an in-person kickoff workshop, regular webinars featuring African women leaders, moderated WhatsApp peer groups, and one-on-one mentoring through small micro-cohorts. The results arrived faster than expected. Within the program’s first months, participants had already implemented infection-prevention improvements in a NICU, increased immediate breastfeeding rates in their units, and launched quality-improvement initiatives; real, measurable, facility-level changes.
Why This Extends Beyond Health
The leadership gap isn’t just a workforce equity issue. When nurses and midwives aren’t represented at policy tables, evidence-based practice doesn’t become a national standard. Bluestone’s example: nurses in many countries are qualified to provide antiretroviral therapy and HIV care, but without professional representation in the rooms where policy gets written, those protocols don’t get codified.
And the ripple effects reach trade and business. Malaria alone threatens economic growth across 13 countries in Sub-Saharan Africa and Asia. As Bluestone put it plainly: “An outbreak anywhere is a health threat everywhere,” and a business risk, too.
For Maryland’s international business community, Jhpiego is a ready partner in markets where health, technology, and trade already intersect. The organization is actively expanding into private-sector engagement, local innovation platforms, and new collective financing models, such as the Healthy Birth Initiative, a government-led effort now operating in both India and Kenya to reduce low birth weight and improve newborn survival.
To stay current on programming and opportunities, follow Jhpiego on LinkedIn — including country-specific pages for Kenya, Ghana, and India.