From humanitarian crisis to employment crisis: The lives and livelihoods of South Sudanese refugee health workers in Uganda.

Despite the many benefits of refugee health workers for health systems, they commonly face challenges integrating into host country workforces. The Global Code of Practice on International Recruitment of Health Personnel, which should monitor and protect migrant health workers, offers little guidance for refugees and research is needed to inform strategy. Based on interviews with 34 refugee health workers and 10 leaders across two settlements supporting populations fleeing the humanitarian crisis in South Sudan since 2013, we describe the governance and social dynamics affecting South Sudanese refugee health worker employment in Uganda. Refugees in Uganda legally have the right to work but face an employment crisis. Refugee health workers report that systemic discrimination, competition from underemployed domestic workers, unclear work permit rules and expensive credentialling processes exclude them from meaningful work in public health facilities and good jobs in the humanitarian response. This pushes them into unchallenging roles in private clinics, poorly remunerated positions on village health teams or out of the health sector altogether. Health system strengthening initiatives in Uganda to integrate humanitarian and government services and to deter the domestic workforce from emigration have overlooked the potential contributions of refugee health workers and the employment crisis they face. More effort is needed to increase fairness in public sector recruitment practices for refugee health workers, support credentialling, training opportunities for professional and non-professional cadres, job placements, and to draw attention to the public benefits of refugee health worker employment alongside higher spending on human resources for health.

When Who Matters: Interviewer Effects and Survey Modality.

When and how to survey potential respondents is often determined by budgetary and external constraints, but choice of survey modality may have enormous implications for data quality. Different survey modalities may be differentially susceptible to measurement error attributable to interviewer assignment, known as interviewer effects. In this paper, we leverage highly similar surveys, one conducted face-to-face (FTF) and the other via phone, to examine variation in interviewer effects across survey modality and question type. We find that while there are no cross-modality differences for simple questions, interviewer effects are markedly higher for sensitive questions asked over the phone. These findings are likely explained by the enhanced ability of in-person interviewers to foster rapport and engagement with respondents. We conclude with a thought experiment that illustrates the potential implications for power calculations, namely, that using FTF data to inform phone surveys may substantially underestimate the necessary sample size for sensitive questions.