Frontline Healthcare Professionals' Perceptions of the Duty to Care During the COVID-19 Pandemic: A Multi-Method Study in Mozambique

COVID-19 intensified ethical tensions between clinicians' duty to care and self-protection amid PPE shortages. We explored frontline healthcare professionals' perspectives in Maputo, Mozambique. Semi-structured interviews with healthcare professionals at four hospitals (April-June 2022) were recorded in Portuguese, transcribed, and thematically analyzed. Fixed-response items were captured in REDCap and summarized descriptively. Fifty-three respondents described varied perspectives on duty. Nearly half affirmed unconditional obligations grounded in professional ethics. Many framed duty as contingent on available PPE and institutional support; 8% were unsure. Themes included irregular PPE distribution, unequal training, and reliance on informal information, shaping perceived risk, preparedness, and responsibility. Quantitative summaries echoed these patterns: only 58% reported receiving training, and as PPE re-supply declined many felt exposed. Sustaining duty to care in resource-constrained settings during an outbreak requires reliable PPE provision, equitable and timely training, and trustworthy communication systems to protect workers and strengthen health-system resilience. Sustaining duty to care in resource-constrained settings during an outbreak requires reliable PPE provision, equitable and timely training, and trustworthy communication systems to protect workers and strengthen health-system resilience.