Face to face: “Everything about health is about behaviour”, says Professor Mosa Moshabela

Face to face: “Everything about health is about behaviour”, says Professor Mosa MoshabelaProfessor Mosa Moshabela, Vice-Chancellor for Research and Innovation at UKZN. PHOTO: Supplied
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Speaking on Zoom from New York City, Professor Mosa Moshabela quietly notes the junctures and dilemmas that shaped his journey from a Limpopo village to the global health stage.

At the time of the interview, Moshabela is in the United States to collaborate with scientists from Harvard University in Boston. They’re working together on a health systems quality project, which they presented at a conference in Bogotá, Colombia, earlier this month.

“A colleague of mine, Professor Margaret Kruk [of the Harvard School of Public Health], did this review for Lancet Global Health that focused on health systems quality,” he explains, “and South Africa was one of the case studies. After they published it in 2017, there was a decision to turn the findings of the report into interventions.”

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Their first meeting was in 2019 in Boston, with other countries represented, including Kenya, Ethiopia, India, Peru, and Argentina.

“The whole intervention,” Moshabela says, “is designed around how to transform health systems. For a long time, we’ve been trying to improve the quality of care at a service delivery point. But the study showed there’s only so much you can do by improving the interface between the patient and the provider if you don’t improve the broader system around them.”

One of the mobile screening and testing units used in KwaZulu-Natal.
Professor Mosa Moshabela led UKZN’s COVID-19 response team. PHOTO: KZN Health

An influential voice on COVID-19

A qualified family physician, Moshabela’s research background is primarily in HIV and TB, with a later focus on health systems and policy. The 43-year-old scholar has an engaged Twitter following. His tweets cover a broad range of topics ranging from long COVID to quantum computing technologies, humanities, and the arts.

Speaking to Spotlight, Moshabela’s voice is low; his sentences long and thoughtful. He highlights the importance of building bridges between disciplines to solve the complex problems of our future. “As data gets bigger and bigger, you will need much more powerful technologies to handle and analyse it. So we will need to collaborate with experts in computer engineering and quantum physics and so on, in building these interfaces. And for me, even though this is uncomfortable as it is not familiar territory, it is the direction we have to take in the 21st century.”

In January this year, the University of KwaZulu-Natal [UKZN] announced Moshabela’s appointment as Deputy Vice-Chancellor of Research and Innovation. Before taking up this position, he was head of the university’s School of Nursing and Public Health at its College of Health Sciences. Moshabela also led UKZN’s COVID-19 response team, advised the provincial health department on COVID-19 through its “war room”, and served on the national health department’s COVID-19 ministerial advisory committee. Moshabela recently also received the Public Health Association’s annual PHILA (Public Health Innovation and Lifetime Achievement) award for his commitment to public health.

‘Everything about health is about behaviour’

At the core of health, he says, is people’s behaviour. “My whole career has brought me to a point where I think everything about health is about behaviour. It’s about wanting to understand other people. Whether you are looking at doctors and healthcare workers, policy-makers, politicians, investors, and business people… You have to understand where people are coming from, to be able to change their minds, to inspire them.

Patients waiting at a screening station at Site B Community Health Centre in Khayelitsha. PHOTO: Nasief Manie/Spotlight
PHOTO: Nasief Manie/Spotlight

“Even in the time of COVID-19, a lot of it was trying to understand what’s going on in the minds of people. I found myself engaging a lot with anti-vaxxers because I wanted to understand where they were coming from.”

Presently, a project near to his heart is establishing the Institute for People-centred Health at UKZN. This is the culmination of his own observations recommending a shift from disease-centred to people-centred healthcare – essentially a shift from merely treating patients at healthcare facilities to addressing broader social determinants of health within a population – which dovetails with the findings of the Lancet Global Health report.

He relays an anecdote to illustrate. “I had this kind of dilemma, where you’re sitting at the bottom of the river and people are drowning and you’re pulling them out, trying to resuscitate them. But you don’t go up the river to stop whatever is letting them fall in. And that’s when I saw the tension between clinical medicine and public health because I was thinking there are all these upstream factors that are making my job as a clinician very difficult. And I’m just waiting until people are near death to resuscitate them and make them better. By that time, they’ve lost their jobs, they’ve lost their livelihoods, they’ve lost their families, and so much harm has already happened in their lives. So then I decided, okay, instead of focusing on the clinical research, I’m gonna start going further up. I want to understand access in terms of what is it that makes it difficult for people, from the time when they’re exposed to HIV to getting into the clinic.”

This research is captured in a paper Moshabela published in the journal AIDS and Behavior in 2011: Patterns and Implications of Medical Pluralism Among HIV/AIDS Patients in Rural South Africa.

“So in that paper, I interviewed a lot of patients and I was mapping their pathways from the time of their first symptoms, until the point where we saw them at the clinic to initiate them on ARVs. And so it was my way of trying to understand their journey to the clinic. Because really, a sick person should be coming to the clinic earlier, they should be in a better condition. And that’s a paper that I’m very proud of.”

He highlights another career-shaping dilemma. “This tension between going to do surgery and doing public health. And it was about – do you do something that you’re interested in yourself, or do you do something that addresses a big problem for everyone?’ So then I chose to do HIV because that was a big problem for everyone.”

Becoming a ‘young carer’

For a young Moshabela, growing up in the citrus-farming village of Zebediela, 60 kilometres south of Polokwane, studying medicine was never contested. As he attended Tubake Senior Secondary School, it was his grandmother who motivated him to learn.

“My grandmother who had not been to school, she loved education,” he says. “And she enabled this inquisitive mind in me and allowed me to ask questions. And she would always answer my questions like she was speaking to an adult.” Moshabela says one of the things that spurred his interest in health was when his grandmother had a stroke. “She was paralysed for about ten years and she also had cardiac failure. She had a combination of medical conditions that essentially resulted in me becoming what we call a young carer.

“She would have episodes that required her to go to hospital and I would get very frustrated that I wasn’t able to assist her. So that was my biggest motivation for wanting to do medicine. In Grade Seven [Standard 5] I decided I wanted to be a doctor. So, when I got to high school I did physics and maths and science. It inspired me to work hard.”

Moshabela’s grandmother did not live to see him qualify as a doctor. But she did see him off on his journey to medical school at UKZN in 1996 when he was 16 years old. And she was shocked when her grandson returned for the midyear break speaking isiZulu.

“She died at the end of my first year,” he says. “But in the middle of the year I came back for holidays and she was very happy to see that I was surviving. She had been worried because there was violence in KwaZulu-Natal then. And I was already starting to speak isiZulu, and she was very shocked by that,” he says, laughing.

Equity targets

Coming from a small rural school, Moshabela’s chances of being accepted to medical school had been slim. He says equity targets got him in.

“Coming from a rural school, you really needed to have those equity targets that were already there in 1995 because of the post-1994-agenda. KwaZulu-Natal was one of those places where they said that people coming from poor schools, will compete amongst themselves, and not directly with people who came from private schools.

So I got admitted into medical school with an aggregate C, whereas someone with four distinctions was not accepted. And someone would’ve said that, well, I did not meet the merit. But that is not necessarily true, because if I had gone to the same school that they had gone to, I would’ve probably done even better than them. And I often use this as an example today. Very few people would argue against the fact that I’m a known scientist in my field. And yet someone else could have said that I didn’t qualify, I didn’t meet the merits to get into medical school. In fact, UCT [the University of Cape Town] and Wits [the University of the Witwatersrand] turned me down…”

Moshabela lives in Durban with his long-term partner.