Perspectives on non-clinical health care workers’ moral obligation to report for work during virulent epidemics: an exploration in Guinea

Abstract

Objectives

To examine the views of non-clinical health care workers (NCHW) and lay people in Guinea on NCHWs’ moral obligation to work during epidemics.

Methods

NCHWs (N = 227) and lay people (N = 253) were presented with theoretical vignettes of NCHWs who refused to work during a virulent epidemic and invited to rate the extent to which such decision was acceptable. Vignettes varied in four factors: level of risk of getting infected; the nature of the infection (Ebola, influenza, tuberculosis); working conditions and the NCHW’s family status.

Results

Three general qualitatively different positions were identified: (a) NCHWs have an unlimited moral obligation to work, irrespective of circumstances (10% of study participants); (b) NCHWs do not have a moral obligation to work (12%), and (c) the moral obligation to work depends entirely on circumstances (58%), while 19% of participants did not express any position.

Conclusions

Only a small proportion of NCHWs and lay people in Guinea considered that NCHWs’ refusal to work during an epidemic is always unacceptable. Policy makers planning for future epidemics need to take account of NCHWs’ moral dilemmas in deciding whether to report to work during epidemics and provide appropriate working conditions.