Internationally educated health professionals and health-system change: A global qualitative study

This article examines how internationally educated health professionals contribute to health system change on return to their countries of origin. Rather than treating return as reintegration or skill application, this study approaches it as interpretive, constrained engagement within health systems. Drawing on interviews with 52 returnees from 43 countries and a comparison group of 14 nationally educated peers, and using an abductive realist thematic analysis, the study identifies four pathways: policy influence, community engagement, infrastructural innovation, and medical education, through which returnees engaged systems. These are underpinned by three mechanisms: reflexive agency, knowledge translation, and civic understanding. What distinguishes returnees is not exclusive access to insight, but the configuration of stance, tempo, scope, and resources. Non-mobile peers contributed through equally committed, often slower and more embedded strategies. The findings challenge instrumental framings of return as skill deployment. International education is understood as a catalytic influence that interacts with home-grown formation to shape how professionals interpret structural conditions, navigate constraints, and assume responsibility.