Impact of COVID-19 Response Strategies on Frontline Health Workers' Motivation: A Case Study in Two Regional Referral Hospitals in Ghana and Uganda.

Background: Several health systems developed interventions and strategies in response to the COVID-19 pandemic, some of which were broad-based, some of which focused on service delivery, and others on frontline health workers. The goal of this study was to see how COVID-19 interventions affected the motivation of frontline health workers in Ghana and Uganda. Methods: The research was undertaken during the period of May to July 2020, coinciding with the initial three months of the global response to the COVID-19 pandemic. This was a critical juncture when the majority of the proposed strategies were in the nascent stages of execution. The research methodology employed was cross-sectional study design, utilizing a qualitative phenomenological approach. The study was conducted across two regional referral hospitals located in Ghana and Uganda. Sixteen frontline healthcare workers from both Uganda and Ghana were selected for interviews, which were conducted both in-person and telephonically. Additionally, one managerial staff member from each hospital was also interviewed. The collected data were subsequently subjected to a deductive thematic analysis. Results: The three themes that emerged from the study include the interventions mentioned by the healthcare workers, the interventions that serve as motivators, and those interventions that act as demotivators. The conceptualization and implementation of the COVID-19 response interventions resulted in differential perceptions regarding their impact on the motivation of healthcare workers in the two hospitals under study. The primary catalysts for healthcare professionals' motivation were the leadership exhibited by their respective governments and supervisors, coupled with certain promises made. These included financial incentives that initially appeared to be motivational, as well as proposals to offer complimentary services. However, the failure to fulfill some of these commitments, along with the unequal distribution of the financial incentives, led to a decrease in motivation among the healthcare workers. Certain human resources for health strategies were perceived as poorly planned and impracticable, resulting in a demotivation among COVID-19 frontline healthcare providers. Conclusion: The COVID-19 response interventions' implementation yielded varied perceptions on healthcare workers' motivation both positive and negative. These were attributed to leadership quality, promises like financial incentives and complementary services, and unmet commitments. The COVID-19 pandemic response strategies in both countries underscore the need for preparedness in the face of unforeseen outbreaks. Failure to sustain healthcare worker motivation may compromise future response effectiveness. Governments must learn from this and come up with well sought of response strategies incorporating health workers' input for comprehensive crisis management. They should establish well-resourced, multisectoral units with specific incentives to handle the response.