In 1993 she opened a women's health clinic in Rivonia, Johannesburg.[17] From 2002 until 2007 she served as President of the Cancer Association of South Africa (CANSA), earning her the Elizabeth Tshabalala Award for her cancer awareness efforts in 2012.[18]
She cofounded the Motsepe Foundation with her husband in 1999, with a mission to contribute towards eradicating poverty and to sustainably improve the living conditions and standards of living of poor, unemployed and marginalized people in South Africa, Africa and the world.[19] In 2002 she took over its leadership as Chief Executive Officer[20] and leads five main programmes: education and leadership; gender equality; community development; sport, music and arts; and social cohesion.[21] In 2012, she spearheaded the Gender Responsive Budget Initiative, advocating for reviews and analysis of national plans and budgets to ensure that the needs of women are specifically and equally addressed.[22] The Gender Responsive Budget Initiative has since been adopted by the South African parliament.[23]
In 2015, she and her husband were honored by the Keep a Child Alive Foundation for their efforts addressing the issues of social and economic inequality of Africa's poorest people, and for their generous support of HIV and AIDS initiatives over the years.[24]
In 2017 she published The Precious Little Black Book to empower South African women with information about their rights, health and economic empowerment.[25] Following this, she took over the reins from Melinda Gates as co-chair of the global women's philanthropic organization Maverick Collective in 2018.[26]
In 2020, she donated R5 million to the University of Cape Town through the Motsepe Foundation. The donation, made at the outset of the COVID-19 pandemic, was allocated to assist with university sustainability, as well as the procurement of laptops and data for students to resume learning remotely.[27]
In 2021, she donated a further R2 million to the University of Cape Town through the Motsepe Foundation, to assist students who completed their studies but were unable to graduate and receive their degree certificates because of student debt.[28] In 2023, through the Motsepe Foundation, she extended her support to all 26 South African universities through a R30 million donation for student registration, fees and historical debt.[29]
In 2007, she conceptualized African Fashion International (AFI) as a socially conscious, luxury African fashion platform[30] that is supposed to propel pan-African designers into international markets and create opportunities for job creation along the supply chain.[31] AFI is best known for its international fashion and lifestyle events production and has since grown into the luxury e-commerce sector as purveyors of fashion and accessories from Africa and the diaspora.[32][33] Becoming the first fashion week platform on the continent sponsored by Mercedes Benz, the front row of AFI Fashion Week has been graced by Suzy Menkes of Condé Nast International and Fern Mallis of New York Fashion Week.[34]
In 2017, she was the first recipient of the Franca Sozzani Award at the United Nations in New York for her efforts to promote African designers through her firm and support the empowerment of disadvantaged women.[35] In 2022 she was selected to join the BOF Global Fashion Leader Index.[36]
She is an advisor to the Copenhagen Global Fashion Agenda Summit, promoting sustainable investments in fashion; the only representative from Africa.[37]
She has been involved in various cultural sectors in Africa, including fashion, art, music, and sports.
In the fashion industry, she has supported pan-African fashion by promoting African designers and sponsoring industry events. In 2019, she sponsored the Condé Nast International Luxury Conference, which was held in Cape Town for the first time.[38] In 2025, she partnered with the Met Gala, collaborating with Vogue and the Anna Wintour Costume Center on an exhibition exploring Black dandyism.[39]
In sports, she has supported school-level athletics in South Africa through the Kay Motsepe Schools Championship, which includes football and netball competitions involving over 13,000 teams.[40] She has also backed the CAF African Schools Football Championship, which brings together teams from across the continent. Additionally, she has advocated for equal pay in women’s sports, particularly for South Africa’s Banyana Banyana football team.[41]
In music, she has supported the ABC Motsepe Schools Choral Eisteddfod, an annual event involving 4,000 schools in various musical categories.[42]