Being a wife is hard enough. Try also being a first lady.

How do you balance your ambitions with the high-visibility role you are thrust into? How do you act as an advocate, often with a small budget, no experience and little respect? And how do you make sure your husband, now the leader of a nation, knows you’re still the boss?

Such questions provide the unofficial syllabus for the Rand African First Ladies Initiative, a program that hopes to foster leadership among the wives of African heads of state. The program — which is seen as especially valuable on a continent struggling to meet the United Nations’ Millennium Development Goals for maternal mortality and girls’ education — is designed to help participants get the tools they need to become agents of change in their home countries.

On a rainy Friday morning at the Ford Foundation, Rosalynn Carter, former first lady of the United States, chatted with Sia Nyama Koroma, first lady of Sierra Leone, while Cherie Blair, wife of former British prime minister Tony Blair, bonded with Mathato Mosisili, first lady of Lesotho.

“One journalist in my country wrote that the first lady used to be just an ornament that decorated the presidential entourage,” Koroma said. “But I am determined to change that. I am not intimidated by the blows and punches of men.”

The program took shape after a 2009 African First Ladies Health Summit that Rand co-hosted in Los Angeles. But it has expanded its scope and come to include women from other parts of the world. The nonprofit corporation runs the program in partnership with the State Department’s African Women’s Entrepreneurship Program and the Corporate Council on Africa.

“One day I was the mother of four children and then I woke up and was suddenly the mother of 20 million. My new job as first lady really has no blueprint,” said Sophia Martelly, the first lady of Haiti, who asked to attend though she is not African.

“When I heard about it, I had to come.”

This year, 10 first ladies came to a morning of workshops at which they discussed how to focus their passions and incorporate them into national agendas. They also discussed how to avoid replicating the work of government programs and how to continue their work once their husbands leave office.

Later, over a lunch of mozzarella salad and steak, the first ladies talked about how they often have to invent their jobs and how they are sometimes overwhelmed by requests from constituents and struggle to champion a single cause. (The program also offers training for their staffers, who are attending five days of workshops this week.)

“First ladies can stay above the fray of politics and really cross a lot of boundaries,” said Anita McBride, who opened Friday’s program. McBride, former chief of staff for Laura Bush, is co-director of the Rand Initiative.

The first ladies said they were relieved to have an open forum where they could spend time with one another without official agendas — and without their husbands and children present. First ladies wearing pantsuits mixed with those sporting West African dresses with matching head wraps.

The attendees are eager to help raise the profile of first ladies, especially in Africa, a continent where women in rural areas do the majority of the domestic and farming work, yet struggle for basic rights such as inheriting land or choosing whom they marry.

Mosisili, the first lady of Lesotho, was a school inspector and was working on expanding the Southern African nation’s school system when she was told she had to leave her job because of security concerns.

“You marry out of love. You don’t think that, down the line, the same person you marry will be a leader and that power will fall on you. You will either sink or swim,” Mosisili said. “The beginning was very tough. I met with lots of red tape. Some male government workers may have felt threatened by me.”

At first, the health and education ministries were concerned she would get in their way, Mosisili said. But after attending the health summit in 2009, she realized she should focus on issues that weren’t being addressed elsewhere; she subsequently devoted herself to combating her country’s stigmatization of children with autism and other learning disabilities.

Since attending the health summit in 2009, Koroma, the first lady of Sierra Leone, has organized religious chiefs to help pass a new law making it illegal for a husband to refuse to take his wife to the hospital.

Koroma is a psychiatric nurse and witnessed firsthand how many husbands do not want to pay for their wives to be taken to hospitals. Some rural husbands were also culturally opposed to having male doctors examine their wives.

She found male pop singers to produce a hit song, whose chorus is: “No women should die whilst giving birth.” She also made a point to reach out to men, “so they can feel they are a part of the change.”

Not all first ladies want to have a voice. In Africa and the Middle East, some of the wives of leaders are known as “Duty Free Ladies” for the luxury shopping they do when they travel abroad with their husbands. And some critics of the idea wonder if resources would be better spent on adding more programs to empower women who are elected to office. Some historians also argue that the office of the first lady is insulting because it assumes that the wives of powerful men don’t have their own careers or that they should be sidekicks to their husband’s work.

Cherie Blair was already a respected lawyer when her husband, Tony, became the British prime minister.

“This was a conundrum I had when my husband became P.M.,” she said in an interview in their New York hotel room. “Just because my husband changed his job to 10 Downing Street didn’t mean I had to change my job. Yet it’s such a unique opportunity and gives you a wonderful platform to do good.”

Tony Blair, just back from the United Nations sessions, weighed in. “Let’s hope there are more powerful first ladies. Even if it’s not an official position in some countries, it’s the bully pulpit that comes with it,” he said, raising his eyebrows and chuckling as he looked at his wife.

“That’s a good amount of power,” she agreed.

Initiative co-director McBride, the executive in residence at American University’s Center for Congressional and Presidential Studies, concurred. “You are married to the leader; why wouldn’t you use that platform?” she asked. “No one gives you more unfiltered advice than the spouse of a leader.”

Melanne Verveer, Hillary Rodham Clinton’s former chief of staff, who attended the program and is now ambassador-at-large for the State Department’s Office of Global Women’s Issues, pointed to Clinton as a symbol of what can be achieved after serving as a first lady.

“We want to share examples of how the first ladies can lay the foundations for work for the rest of their lives,” said Rand Initiative co-director Cora Neumann, who partnered with the first ladies to develop the program after conversations with them about their needs at the 2009 health summit. “It doesn’t have to be over when their husbands leave office.”

Nearby, Penehupifo Pohamba, the first lady of Namibia, said the program helped her secure a budget for the first time for her office, which is now working to improve access to children’s health care and combat HIV/AIDS.

When the former midwife was asked if she would one day want to lead her country and send her husband to a First Gentlemen Initiative, she smiled and said, “Well, that would be something.”