The Health, Equity, Action, and Leadership (HEAL) Initiative fellowship based at the University of California San Francisco (UCSF) is one model for training and transforming future health care leaders. The HEAL Initiative is a two-year multidisciplinary fellowship founded on principles of equity, humility, solidarity, and community. The HEAL Initiative recognizes that health is deeply influenced by economic, racial, and power inequities that exist within society and that understanding this structural violence requires witnessing it first-hand without looking away.11,12

Each year, HEAL recruits an interprofessional cohort of 20–30 fellows from around the world to immerse themselves in domestic and international resource-denied communities. The HEAL Initiative collaborates with a network of partner hospitals and nongovernmental organizations who have spent decades serving patients in their communities. Fellows come from diverse professional backgrounds including physicians, nurses, program managers, pharmacists, and community health workers. Among physicians, HEAL recruits across medical specialties including surgery, anesthesiology, and obstetrics and gynecology (OB/GYN). The HEAL Initiative is designed to be bidirectional, with half of each cohort representing underserved, resource-denied communities in the USA and abroad. As “site fellows,” these professionals are often employed by hospitals and organizations at HEAL partner sites. Site fellows possess deep experience with the historical structures challenging their communities and impacting care.

The other half of each cohort is composed of “rotating fellows,” who spend one year at a domestic HEAL partner site and the second year at an international partner site. Most rotating fellows are physicians and recent residency graduates. Domestically, their primary focus is providing clinical care as attending physicians while internationally the focus is on program implementation, clinical care, and community engagement. Over the course of two years, HEAL fellows collaborate and challenge one another through regular training, journal clubs, and narrative assignments focused on the program’s pillars of structural competency, power and privilege, leadership, and advocacy. Structural competency can be defined as, “the capacity for health professionals to recognize and respond to health and illness as the downstream effects of broad social, political, and economic structures.”13

The HEAL Initiative’s funding model centres on the fact that high cost, short term, locums providers are commonly used to fill the large vacancies in health care jobs in rural and Indigenous communities in the USA.14 The HEAL Initiative instead fills a single open position in a workforce shortage area with two post-residency trained physicians who split one full-time equivalent (FTE) over the course of two years. While one fellow works internationally, the other works in Navajo Nation, and vice versa. The fellows are compensated at the equivalent of a postgraduate year-5 salary and the remainder of their FTE supports a Navajo health worker and an international health worker to join the fellowship from HEAL’s partner sites. One FTE funds four health workers creating a redistributive justice model that builds local capacity and fills open positions in high-need areas with trained specialists.

Every HEAL fellow is provided support for professional development including funding for higher education (e.g., master’s degree) or further training (e.g., point-of-care ultrasound). HEAL draws upon its alumni base to help teach, develop curricula, and provide mentorship to fellows and alumni. Through its affiliation with UCSF, the program offers access to a large network of physicians and resources for clinical support, continuing medical education, and research collaboration.

The HEAL Initiative has developed partnerships with domestic sites including Natividad Medical Center in Salinas, CA and multiple facilities on Navajo Nation, the largest Native American reservation in the USA. International partner sites exist in Mexico, Haiti, Mali, Liberia, Rwanda, Malawi, Uganda, India, and Nepal, spanning organizations including Partners in Health, Jan Swasthya Sahyog, Muso, and Last Mile Health (Figure). All current HEAL rotating fellows in surgery, anesthesia, and OB/GYN are based in Navajo Nation and Uganda as part of a collaboration between the UCSF Center for Health Equity in Surgery and Anesthesia and Busitema University.

Map of HEAL partner sites (used with permission of the HEAL Initiative)11