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«February 2019»

Fellow Seminar

12 April 2018

Dr. Neda Deneva will present her research proposal on the topic: "Return Migration of Health Professionals and the Transformation of Medical Practice in the Field of Maternal and Child Health in Bulgaria" on 12 April 2018 (Thursday) at 16:30h.


At the Fellow seminar at CAS I will present the research proposal and first findings that I have in this field and discuss potential openings and directions for developing the research. Below is a description of the rational of the research project.

The project seeks to understand and explain the ways in which return migration of health professionals back to Bulgaria affects the transformations of medical practice at an individual and at a systemic level. The particular focus is on returning medical specialists in the field of prenatal, natal, and neonatal care. The research uses a mixed-methods approach integrating qualitative in-depth interviews with health professionals and various actors in their networks, and policy analysis of the institutional framework. Drawing on the concept of medical habitus, the project formulates the hypothesis that return migration creates the potential for transformations in the medical practices by exposing mobile professionals to alternative medical systems and modes of practice. It thus aims to examine the role of returning health professionals as drivers of change, for the advancement of knowledge transfer and improvement of health systems at home. Given this research agenda, the project will examine three interrelated questions: How do returning health professionals experience and asses differences in medical practices and health systems? How do health professionals re-integrate in their home health systems and what kind of networks do they build? What transformative steps do returning health professionals take to advance medical knowledge and practice in their home countries?

The economic and social conditions for Bulgarian health professionals have hardly improved over the last decade, nonetheless there seems to be a growing niche for returning medical specialists to engage in a variety of activities that create both profitable and professional development opportunities, as my initial research in this topic demonstrates. This small, but influential category, has been overshadowed by the analysis of ‘brain drain' and their attempts for re-integrating in their home countries' health systems have remained unnoticed. The vectors of this ‘return migration' are far from simple or unidirectional. Some return after several years of education, others have migrated with the sole purpose of specialization unavailable at home, yet others have worked for a number of years, before deciding to restart practicing at home. A diverse group, return migration comprises classical examples of long-term settlement in the home country, as well as novel patterns of mobility which involve circular movements, highly intensive, short-term regular mobilities, and sometimes simultaneous professional incorporation in more than one country, which is transborder in its character. For the purposes of this research, the term return migration will denote a variety of professional mobilities that involve exposure to a different health system and medical practice, that is followed by some form of re-incorporation into the home labour market, be it full time and long-term, circular, or temporary.

Medical standards and protocols, guidelines, and concrete everyday ways of practicing and relating to patients, tend to differ between health systems. These divergences manifest themselves sharply in the field of pregnancy, child birth, and neonatal care, when comparing Eastern European countries with countries like Germany, France, or the UK, which are the main destination countries for migration of health professionals from Bulgariaл Medical systems are conservative and hierarchical institutions that follow rigorous protocols, assign strict distribution of tasks and roles, and require from their practitioners the adoption of a certain habitus and establishing of authoritative knowledge through certainty (Luke 2003), of certain modes of being and acting, and of relating to other actors (including patients) (Holmes and Ponte 2011). Practicing in different systems creates the potential for a rupture and requires more than a simple readjustment, it requires a profound transformation of professional habitus. Through various types of migration (labour or professional specialization) health professionals are exposed to alternative models of medical practice in their field. Having gained experience from different medical systems and practices, and/or further medical specialization, the return health professionals bring back not only their labour force, but the potential for advancement in knowledge and innovation and to trigger change in their home health systems. Thus, my main hypothesis is that migration creates ruptures in the medical habitus and is a driver for change in the way medical situations and conditions are perceived and approached. Moreover, this opens up the possibility for further steps into transforming the medical practice at a systemic level through changes in medical standards, hospital regulations, and state policies. In this context, the return health professionals can act as main agents of change both at individual and at systemic level.



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