This paper examines how practices of leadership have been negotiated and have changed over time in the context of a grassroots health promotion project in Lima, Peru. Tracing these trajectories in the context of the evolution of women's organising in Peru informs a broader analysis of the changing role of grassroots women in development projects, feeding into debates around the professionalisation and depoliticisation of grassroots activism and providing new empirical material on gendered experiences of grassroots leadership. The paper recognises the increasing dominance of neoliberal management mechanisms but argues that the depoliticisation of grassroots women leaders is not simply a straightforward trickledown of neoliberal development practices but is produced through the interplay of local socio-political processes and personal biographies of activism with more macro-level development trends and discourses.