Back home, beyond borders: a bioecological study of returnee public health scholars in a globalized health system.

Abstract

Background: Cross-border postgraduate education is reshaping the public health workforce, yet little is known about what "return" looks like in aid-reliant health systems where authority, resources, and evidence are co-produced across government, research institutes, and international organizations. In Nepal, internationally trained public health scholars re-enter a mixed institutional landscape shaped by global higher-education markets, donor accountability regimes, and transnational procurement and supply chains. This study examines how Nepali returnees translate overseas training into system-facing work upon returning home, and how the timing of key milestones shapes what becomes actionable.

Methods: Semi-structured interviews were conducted with 12 Nepali public health scholars who returned after postgraduate study abroad (five doctoral graduates; seven master's graduates) and were working in Nepal at two research institutes and two international non-governmental organizations. Positive deviance purposive sampling targeted returnees with identifiable system impact. Data were analyzed using applied thematic analysis, guided by Bronfenbrenner's bioecological model (micro-, meso-, exo-, and macrosystems), with the chronosystem examined as a cross-cutting influence.

Results: Four interconnected themes described patterned engagement across ecological levels. (1) Microsystem-reconstituting role and voice at home: return decisions were anchored in close relationships and early workplace recognition, with a time-sensitive shift from "credentialed outsider" to trusted colleague. (2) Mesosystem-boundary navigation: participants described convening and translating across institutions, with coordination accelerating after early probation and crystallizing around budget cycles, grant windows, and emergencies. (3) Exosystem-rules, resources, and distant decision-makers: procurement timelines, ethics review procedures, donor reporting templates, and customs/banking processes frequently determined the feasibility and tempo of reforms. (4) Macrosystem-national imaginaries, credential politics, and moral horizons of work: participants described credentials as opening initial doors, but sustained legitimacy depended on visible delivery amid shifting political and administrative cycles; some trained in regional Asian hubs emphasized the practical transferability of methods and policy argumentation. Across themes, timing mattered: family events, contract endings, fiscal quarters, monsoon disruptions, and crisis periods re-shaped constraints and opportunities.

Conclusions: In this cohort, returnee contribution was bioecological and time-sensitive: agency was not simply "brought home," but assembled through relationships, cross-organizational brokerage, arm's-length governance, and national legitimacy contests, all modulated by temporal milestones. Treating return as a time-sequenced ecology of action-rather than skill transfer-can better inform how governments, funders, and academic institutions design re-entry supports, procurement and reporting architectures, and evidence-use processes so that international learning more reliably translates into public value.

Clinical trial number: Not applicable.