She has served as the Gauteng MEC (Member of the Executive Council) for Health and Wellness since October 2022.

When she returned to South Africa, she started working as a political education officer at the same trade union.

She served as Baleka Mbete's personal assistant, when she was still the secretary-general of the African National Congress Women's League.

[2][3] Due to a fallout between her and premier Nomvula Mokonyane, she resigned as MEC on 5 June.

Due to public outcry, Makhura reshuffled his executive a day later and made Nkomo-Ralehoko and Lesufi swap positions.

[8][9] Following the election of Panyaza Lesufi as Gauteng premier in October 2022, she was appointed MEC for Health and Wellness.

[10] Nkomo-Ralehoko was reappointed as the MEC for Health and Wellness by premier Lesufi following the 2024 provincial election.