Background The COVID-19 pandemic placed healthcare workers worldwide under significant physical and psychological stress due to increased workplace demands causing fatigue and burnout. In addition, shortages in personal protective equipment (PPE) were commonly, leading to fears for their own personal safety. The pandemic also renewed ethical questions about how to reconcile healthcare workers´ duty to care with concern for their personal health, safety, and well-being. Our study aimed to explore this dynamic from the perspectives of frontline healthcare workers.

Methods We conducted a mixed-methods, descriptive study in which we carried out semi-structured, in-depth interviews in April-June 2022, with frontline healthcare workers at four hospitals in Maputo Province, Mozambique. Qualitative interviews were audio-recorded, transcribed and entered into Microsoft Excel for content analysis. Quantitative data was entered in REDCap with descriptive analysis in SPSS.

Results We interviewed 53 frontline workers (physicians, nurses and assistants). When asked about their ethical responsibility to provide care during a pandemic, 20 (38%) respondents affirmed that, despite the risk, they had an obligation to care for patients with COVID-19, even without PPE, due to their professional commitment. Eighteen participants (34%) stated that they were not obligated to provide patient care, without PPE, due to the risk of contracting the virus. The remaining 15 (28%) said that they would take care of patients in rare situations. Thirteen (25%) respondents reported first-hand knowledge of examples during the pandemic in which patients were discriminated against in the health care setting, received poor care, or had health workers who refused to provide them care all together.

Conclusion Our findings show that frontline healthcare workers in Mozambique were divided as to the limits of their professional responsibility to care for patients with COVID-19. Risk management strategies for highly infectious diseases like COVID-19 must be reformulated to improve service delivery while safeguarding providers.