Dr Vuyo Gqola is an accomplished healthcare executive and a registered Medical Practitioner with extensive experience in clinical practice, managed care, and healthcare leadership. She currently serves as the Chief Operations Officer (COO) of GEMS, where she plays a pivotal role in overseeing the Scheme’s strategic operations, ensuring efficiency, sustainability, and the continued delivery of high-quality healthcare services to members.

Before assuming the role of COO, Dr Gqola served as Chief Healthcare Officer (CHO) of GEMS from 2015 to 2024. In this capacity, she led key initiatives in managed care services, clinical risk and medicine management, healthcare networks, provider relations, tariff negotiations, and strategic healthcare purchasing.

Dr Gqola also contributes to the broader healthcare industry by serving on the Board of Health Quality Assessment (HQA), a not-for-profit organization that conducts annual assessments of quality in healthcare by medical schemes, with the aim of assisting medical schemes to improve the quality of care received by members.

Academic Qualifications

• Bachelor of Science (BSc) – University of KwaZulu-Natal (UKZN)
• BSc (Hons) in Microbiology – UKZN
• Bachelor of Medicine and Bachelor of Surgery (MBChB) – University of Cape Town (UCT)
• Master of Business Administration (MBA) in Health Care Leadership – University of Stellenbosch
• Certificate in Expert Negotiation – Gordon Institute of Business Science (GIBS)
• Certificate in Global Health Delivery – Harvard University
• Certificate in The Strategy for Healthcare Delivery – Harvard Business School

Career Highlights

• Successful implementation of care coordination through the establishment of the Emerald Value and Tanzanite One option, leading to increased access to care and improved health outcomes. The Emerald Value option was awarded the 2019 Board of Healthcare Funders (BHF) Titanium Award for Creating Access to Healthcare
• Progressive implementation of alternative reimbursement models (ARMs), including value-based care programs in ambulatory and in-hospital care
• Part of the team that successfully implemented Claim Management interventions, which resulted in positive deviations in the Scheme’s budget and significant improvement in the Scheme’s financial sustainability; and
• The successful implementation of primary and preventative care benefits in line with Universal Coverage (NHI) in 2018.

As COO, Dr Gqola remains committed to driving innovation, operational excellence, and strategic leadership in healthcare delivery, ensuring that GEMS continues to serve its members with high-quality, accessible, and sustainable healthcare solution