Five Questions With…Dr Matshidiso Moeti

What inspired you to work in global health?

My appreciation of global health has grown with each year that I work in this field. After starting my career as a medical doctor, I had a small child and I wanted to continue my studies to be a paediatrician. However, there was no medical school in my country and I would have had to leave my child and family for several years, so I looked into public health.

I had worked on a TB ward in a district hospital – this was my first introduction to communicable disease prevention and control in my career. It was something I really enjoyed, and I started to see first-hand the great value of preventive and community-based interventions.

At home though, my parents both worked in public health and so it was a common topic of discussion. My father worked in smallpox eradication and often drove out to remote communities to support vaccination campaigns.

So there were a number of influences that shaped my decision to pursue a career in global health and it is a rewarding field. The challenges we face are evolving and require the efforts of many individuals to make a difference. In my lifetime, we have seen these efforts pay off with reductions in deaths among mothers, children and infants, curbing the HIV epidemic, and moving very close to a polio-free world.

What do you believe that women in particular bring to global health?

Women have a tremendous impact on global health. WHO recently published a report, Delivered by Women, Led by Men[1] and I think this tells us a lot already – 70% of people working in global health are women, yet we hold only 25% of senior roles.

As the first woman to be elected WHO Regional Director for Africa, I regularly see the impact of this disparity. From panels with only one, or sometimes, no female speakers, to high-level meetings with only a few female participants – if we only hear from a select, non-representative group of people, then collectively we miss out on a range of potentially useful ideas and perspectives.

It can be difficult to understand issues that do not directly affect us and so it is important to have women involved in making decisions on issues that affect women. We see this in discussions around reproductive and sexual health, access to birth control and obstetric and postpartum care. We also see this when we look at challenges in accessing health care and gender considerations in health research.

We know that equality benefits societies because it means more innovation, more opportunities, and better health and education. We need to continue to pay attention to power imbalances, privilege, stereotypes and discrimination and we need decision-makers that intimately understand these issues.

What do you believe are the biggest challenges faced by women who wish to work in health and what can be done to overcome these challenges?

Health affects all aspects of life and society and there are many opportunities in this field. However, we often see women working in lower-status, lower-paid jobs in health – when we look for people to fill roles as unpaid champions advocating specific health issues or community health workers, we often find women ready to volunteer. So adequate remuneration and closing the gender pay gap is a key challenge.

It is often more difficult for women to gain professional recognition and validation in the work place. People take for granted that men are competent – there is more pressure on women to prove ourselves. As people progress in their careers, the professional experience and expertise of men is increasingly valued, but women are too-often overlooked – hence we have a so few women employed in leadership roles in global health.

Balancing or integrating work and life is another key area – health workers have their own lives and loved ones that they need to care for and spend time with. In recent years WHO has increased paid maternity leave to 24 weeks and paternity leave to four weeks. With digital health there are more opportunities for teleworking and having geographically dispersed teams, although in some key contexts we do need people to be present for long hours and in remote locations to deliver on WHO’s mandate. As colleagues we should be cognizant of the needs and priorities of our peers and work together to accommodate important events in people’s lives.

At WHO we have a zero-tolerance policy on sexual harassment and exploitation and mandatory training for all staff – this is something I encourage all organizations to adopt. Beyond policy, we should all actively create a safe space for staff and beneficiaries to raise concerns. In briefings with new staff I share information on WHO’s whistle-blower hotline, the Staff Association, the ombudsperson and other services and processes staff can use.

Finally, as individuals, we need to invest more in building relationships and professional development. Women working in health need to get to know and to support each other. In my career I’ve followed this principle: be clear what you want to achieve, and go for it, achieve it, but also be empathetic and support the people you work with.

I really enjoy working with young women and it is important that those of us in senior roles take the time to invest in the next generation. Mentors have guided my career choices and development. Often my mentors have been men, as they have been in leadership roles, and they have encouraged me to take on new and bigger challenges.

What has been the highlight of your career so far?

Serving as WHO Regional Director for Africa is a clear highlight for me and an honour. I have now been in this role for almost five years and have seen the Region evolve, particularly in the progress Member States are making towards universal health coverage (UHC).

Ensuring people can access the services they need without facing financial hardship, leads to improvements in life expectancy, well-being and national development. Out of 47 Member States in the African Region, 40 now have national health plans to guide efforts towards UHC. Most countries in the Region are implementing reforms to achieve UHC, from financing reforms in Gabon, Mali, Kenya, Senegal, South Africa and Zambia, to service package design reforms in Eritrea, Ethiopia and Mozambique.

Through our regional flagship programme on UHC, we have worked with 16 countries (Benin, Cameroon, Eritrea, Eswatini, Ethiopia, Ghana, Kenya, Madagascar, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan, Tanzania, Togo and Zambia) to develop road maps for UHC, in line with the Framework for health systems development towards universal health coverage in the context of the Sustainable Development Goals in the African Region. Leading my team in providing technical support to these efforts, and working alongside ministers of health and partners to advocate and ensure political commitment, is a daily reminder for me that we are moving closer towards making health for all a reality.

Looking further back in my career, when I worked as a programme manager for HIV/AIDS in Africa: Dr J. W. Lee, then WHO Director-General, had launched the “3 by 5” initiative – aiming for three million people living with HIV/AIDS in low- and middle-income countries to be receiving antiretroviral therapy (ART) by 2005. I worked on persuading governments that if we gave nurses clear instructions and supervision, they would be able to start people on HIV treatment. The HIV burden in Africa at that time was devastatingly disastrous – it was an injustice that people across the Continent could not access treatment. By empowering nurses to start people on ART, countries were able to expand access to treatment and we started to see the transformation of HIV/AIDS from a death sentence to a chronic disease.

What do you hope the global health community will be able to achieve in the future?

Collectively, as part of the international community, we are working towards achieving the Sustainable Development Goals (SDGs). The SDG health targets call for continued work to reduce deaths among mothers, children and newborns and to combat communicable disease epidemics. These are areas where we have made, and continue to make, significant progress.

At the same time, the targets focus on achieving universal health coverage – this is a priority for WHO globally and in the African Region. It is my hope that by 2030, all people will have equitable access to quality, essential services, without suffering financial hardship. At the same time, we need to maintain efforts to prevent disease and promote good health through work with other sectors. We will continue working with Member States and partners to make this happen.

[1] WHO (2019). Delivered by women, led by men: a gender and equity analysis of the global health and social workforce, human resources for health observer series no. 24. Available at: https://apps.who.int/iris/bitstream/handle/10665/311322/9789241515467-eng.pdf