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

Abstract

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.

The workforce crisis in healthcare: Moving the debate to bridge evidence and policy

“…The studies also put a spotlight on governance gaps at the crossroads of formal labour markets and informal work that may threaten individual HCWs and hamper labour market capacities. [35][36][37] Sensitivity to inequalities within the HCWF are another area that require policy attention. The problems are discussed from a theoretical perspective 38 and indicators proposed that can produce data and inform policy measures.…”

“…33 Studies on new or under-researched groups of HCWs in LMIC countries bringing novel solutions as well as vulnerable groups of HCWs in need of better protection into view. Community health workers (CHWs) 29,34 and refugee or displaced HCWs [35][36][37] show how these groups might help to mitigate HCWF shortages. The studies also put a spotlight on governance gaps at the crossroads of formal labour markets and informal work that may threaten individual HCWs and hamper labour market capacities.…”

“…26 An illustrative example of the need for multi-level and transsectoral HCWF governance approaches can be seen in the research on refugee and displaced HCWs. [35][36][37] Policy failures and missing connections between health policy, human rights, and migration policy push these HCWs into the informal care sector, where they remain confined as voluntary workers. Governance gaps thus prevent effective use of available competencies, adversely impacting both the health system and individual HCWs.…”

Considérations clés : Atténuer l’insécurité alimentaire chronique au Soudan du Sud

“…Le Soudan du Sud subit une inflation galopante et une dépréciation de sa monnaie. 45 Les prix du marché des produits de base, tels que la nourriture, les vêtements, le savon et le sel, ont augmenté, ce qui les rend inabordables pour les populations. Compte tenu de la diversité naissante de l'industrie sans lien avec le minimum vital, le pays dépend fortement des marchandises importées, principalement des pays voisins.…”