A nurse, advocate, and former Minister of Health: Sheila Tlou on breaking barriers in the fight for global health equity

20 April 2023

Throughout the past few decades, Professor Sheila Tlou, a nurse, HIV prevention advocate and Botswana’s former Minister of Health, has wasted no time in using her talents both as a theatre practitioner and as a leader in health policy, to make a lasting change in the health of populations in Eastern and Southern Africa.

“I tell people, I’m a nurse and that means I’m one of everybody,” says Tlou, “nurses are a formidable and passionate force, and I say to all the young nurses out there, we can make an impact anywhere and everywhere we go.”

Tlou will celebrate National Nursing Week at the University of Toronto’s Lawrence Bloomberg Faculty of Nursing this May. Her keynote, Breaking Barriers: The Future of Nursing and the Fight for Global Health Equity will take place on May 9, 2023, at Innis College and will weave together stories of her own experiences as a changemaker in health policy and global health through her work with the World Health Organization, UNAIDS, and International Council of Nurses (ICN) where she has tackled issues around HIV transmission and prevention especially in women and children.

Of her many accomplishments, which have included being a member of parliament for the Republic of Botswana, and Director of the WHO Collaborating Centre for Nursing and Midwifery Development in Primary Health Care for Anglophone Africa, Tlou says that she is most proud of her work saving the lives of children and their mothers by significantly lowering rates of HIV transmission in communities in Botswana.

When Tlou first began her work in this area as Minister of Health, the rate of mother to child HIV transmission was very high. To address this urgent issue, Tlou created a comprehensive HIV/AIDs prevention strategy that included engaging with community members and chiefs in preparation for rolling out an education and awareness campaign focused on HIV testing especially for pregnant women, as well as treatment with antiretrovirals.

By speaking with women and those supporting them in child rearing, including partners and mothers-in-law, Tlou and her team of nurses, nurse practitioners, and midwives were able to change the stigma around HIV and encourage early testing, shifting the community’s perspective and focus onto efforts that helped bring healthy infants into the community. Within four years of implementing this community-engaged approach Tlou’s efforts successfully reduced the rate of mother to child transmission from 30 per cent in 2003 to 8 per cent in 2008.

“This success was really saying to the world, look at what can be achieved in a resource limited area through the intervention of nurses,” says Tlou. “Now the rate of transmission is less than 1 per cent, and the stigma is so low that many women continue to get tested, however the rates of infection of HIV among women remain very high and that is still something that needs to be addressed.”

For Tlou, her advocacy has always been centered around issues of gender and empowering women to improve their health through education. Before she became a nurse, Tlou was passionate about theatre, originally planning to become an actor or interpreter for the United Nations because of her love of languages. However, with only health sciences scholarships available to her as a young university student, Tlou entered the nursing program at a university in New Orleans opting to take public health and theatre as electives to foster her talent for engaging with people.

After completing her master’s degree in nursing education and instruction from Columbia University, Tlou returned to Botswana to teach community health nursing where she also co-directed a travelling theatre that performed plays, with some imparting health focused messages about family planning and spacing pregnancies.

“Being able to take this practical public health message out into the communities and villages was uplifting for the nursing students involved, because they could see the impact of community engagement from a nursing perspective,” says Tlou.

Though technically retired, Tlou has yet to slow down and continues to work actively in health promotion strategy consulting with the African Union, the United Nations and WHO on reducing deaths from Malaria in addition to her work with HIV/AIDs.

During Nursing Week and beyond, Tlou wants to reiterate for nurses everywhere the importance of not just bedside nursing, but community impact, and the ability of nurses to break down barriers that contribute to inequity in health care.

“My advice to current and future nurses is to look at UN Sustainable Development Goals in your region, meet with nursing associations, find your niche,” says Tlou. “As nurses we need to make ourselves visible, and that includes in how we mentor the next generation. The differences I have made are also because of my mentor who was a leader and a nurse.”