Assessing Workplace Motivation in the Zambian Health Sector amidst the COVID-19 Pandemic: A Case Study of Levy Mwanawasa General Hospital

Abstract

The study was assessing workplace motivation in the Zambian health sector amidst the covid-19 pandemic at Levy Mwanawasa General Hospital. A mixed-methods research design was adopted for this study. The population comprised frontline healthcare workers at Levy General Hospital who served during the COVID-19 pandemic. 40 frontline healthcare workers were sampled. A combination of purposive sampling and random sampling was used, and quantitative data was collected through structured surveys and analyzed using statistical techniques such as descriptive statistics and cross-tabulations, and qualitative data was thematically analyzed using coding techniques to identify recurring themes. The study demonstrated that while a supportive work environment and material support were key motivators, financial incentives were more influential than recognition in sustaining frontline healthcare workers’ commitment during the pandemic. The findings also revealed that non-financial incentives such as recognition were more consistently motivating than structural incentives like promotions, underscoring the importance of both immediate and long-term support mechanisms in healthcare settings. The study highlighted that frontline health workers at Levy Teaching Hospital are strongly motivated by a supportive work environment characterized by teamwork, cooperation, and a family-like atmosphere. The study established that frontline healthcare workers at Levy Teaching Hospital are primarily motivated by a combination of intrinsic and extrinsic factors, with recognition for their service emerging as the most powerful driver, followed closely by financial incentives and supportive work environments. While allowances, pre-service training, and material support play important roles in sustaining engagement, opportunities for promotion were less influential, reflecting structural limitations during the pandemic. These findings support Herzberg’s Two-Factor Theory and other research, showing that immediate recognition, sufficient resources, and a teamwork-focused workplace are more important for keeping motivation during health crises than long-term career growth.

Keywords: Motivation, Healthcare workers’, Work Performance, COVID-19, Working Environment

1 Introduction

Employee motivation is one of the most critical drivers of organizational performance and productivity. Across sectors, organizations invest heavily in both short- and long-term strategies to ensure that their workforce remains engaged and committed, recognizing that employees are not merely operational inputs but the determining force behind the success of any institution. Classic studies such as the Hawthorne Experiments by Mayo (1924–1932) highlighted that employee attitudes, perceptions, and the conditions under which they work significantly influence output.

Ryan and Deci (2000) argued that organizational performance is closely linked to an employee’s level of motivation, which is shaped by both individual competencies and the work environment provided by the employer. In line with this, Nimusima and Tumwine (2016) observe that motivation acts as a powerful force that drives employees to perform optimally, while also encouraging organizations to invest in supportive conditions that help achieve shared goals.

Motivation has long been recognized as central to organizational performance. Classic theories such as Maslow’s Hierarchy of Needs, Herzberg’s Two-Factor Theory, and Vroom’s Expectancy Theory provide frameworks explaining how individual needs, workplace conditions, and perceived rewards shape employee behavior. According to Maslow (1943), employees are motivated when physiological, safety, social, esteem, and self-actualization needs are met. Herzberg (1959) distinguishes between hygiene factors such as salary and work conditions and motivators like recognition and achievement, while Vroom (1964) emphasizes the link between effort, performance, and reward expectancy.

Globally, several studies have been conducted to assess motivation of health care professionals amidst the COVID-19 pandemic; however, the majority of these studies focus on other continents, with very little data available for Africa, specifically Zambia. This lack of context-specific research limits policymakers’ ability to design effective interventions to maintain morale during public health crises. In Zambia, empirical research on employee motivation has largely focused on the public service rather than healthcare institutions. Studies have revealed motivation determinants among civil servants, highlighting low pay and limited recognition as major demotivates (Chileshe, 2018).

Given this centrality of motivation to organizational success, understanding how it operates, especially in high-pressure environments such as healthcare during a pandemic, becomes essential. This study therefore explores the motivational experiences of healthcare workers at Levy Mwanawasa University Teaching Hospital during the COVID-19 pandemic, examining how various factors influenced their performance, resilience, and commitment in the face of unprecedented challenges. By focusing on one of Zambia’s primary COVID-19 response facilities, this study addresses an important research gap and contributes new empirical evidence on motivation under extreme conditions.

2 Review of Literature

2.1 Motivation

Motivation has long been understood as the internal and external forces that guide human behavior towards desired goals. The term derives from movere “to move” capturing the energizing and directional function of motivational drivers (Ryan & Deci, 2000). Robbins and Judge (2019) define motivation as the willingness to exert high effort to achieve organizational goals, while Latham and Pinder (2005) emphasize the continuous interaction between personal dispositions, tasks, and situational factors.

Traditional perspectives, such as Maslow’s hierarchy of needs, have offered foundational insight into human drives but are often criticized for assuming linear progression and cultural universality. Contemporary approaches, including the Self-Determination Theory, highlight autonomy, competence, and relatedness as social-psychological determinants of motivation (Deci and Ryan, 2000). However, such theories are often developed in stable environments and therefore struggle to fully explain motivation during crises such as pandemics.

In Zambia, where chronic understaffing, shortages of protective equipment, and delayed allowances were widely reported, traditional theories fail to capture the emotional and physical burden placed on health workers. This gap suggests that existing literature does not sufficiently explain how motivation manifests in environments characterized by heightened risk and limited support. Therefore, motivation in this study is conceptualized as a multidimensional construct shaped by intrinsic values, external incentives, emotional strain, and institutional support all operating simultaneously under crisis conditions.

2.2 Employee Motivation in the Public Sector

Motivation in public institutions is shaped by bureaucratic norms, resource constraints, and public-service values. Unlike private organizations, public entities often operate under fixed pay structures and limited incentives, making motivation more complex and vulnerable to external shocks (Perry, 2010; Wright, 2001). Agency theory emphasizes the role of extrinsic incentives such as allowances and improved working conditions (Jensen & Meckling, 1976), and several studies confirm the influence of financial rewards on employee performance (Gupta and Mitra, 1998; O’Donnell & Shields, 2002). Yet these findings are frequently criticized for assuming well-designed performance systems, which are often weak or inconsistent in developing countries (OECD, 2019).

Non-financial motivators also play an important role. Research from the UK’s National Health Service found that recognition, supportive leadership, and goal clarity motivated employees even when financial rewards were insufficient (Dowling & Richardson, 1997; Redman et al., 2000). These studies, however, have limited applicability in low-resource contexts where basic needs such as safety equipment, medical supplies, and adequate staffing remain unmet.

African studies illustrate the complex reality of public-sector motivation under resource scarcity. Findings from Tanzania, Kenya, South Africa, and Uganda show that inadequate pay, poor supervision, and unsafe work environments consistently undermine health worker motivation (Manongi et al., 2006; Mathauer and Imhoff, 2006; Blaauw et al., 2013). Yet these same studies also reveal strong internal drivers, including professional pride and community trust. The contradiction of high intrinsic motivation but weak extrinsic support shows why many health systems struggle to retain staff.

2.3 Theory of Motivation

This study was guided primarily by Herzberg’s Two-Factor Theory of Motivation and Maslow’s Hierarchy of Needs, which together provide a robust framework for assessing workplace motivation among healthcare workers during the COVID-19 pandemic. Herzberg’s Two-Factor Theory distinguishes between hygiene factors (such as salary, working conditions, job security, and institutional policies) and motivators (including recognition, responsibility, achievement, and professional growth). According to Herzberg, the absence of hygiene factors leads to dissatisfaction, while the presence of motivators enhances job satisfaction and performance (Herzberg et al., 1959). In the context of the COVID-19 pandemic, healthcare workers faced heightened risks, inadequate personal protective equipment (PPE), long working hours, and psychological stress. These conditions directly relate to hygiene factors, which, if insufficient, negatively affected motivation and morale. At the same time, motivators such as recognition for frontline work, opportunities for skill development, and involvement in decision-making were critical in sustaining commitment among health professionals during the crisis.

Maslow’s Hierarchy of Needs complements this framework by emphasizing that human motivation progresses from lower-level physiological and safety needs to higher-level social, esteem, and self-actualization needs (Maslow, 1943). During the COVID-19 pandemic, safety needs such as protection from infection, job security, and access to adequate health resources became particularly salient for healthcare workers at Levy Mwanawasa General Hospital. When these foundational needs were threatened, higher-level motivational factors like professional recognition and self-fulfillment were harder to achieve. Applying Maslow’s theory to this study helps explain variations in motivation among health workers based on the extent to which their basic and psychological needs were met during the pandemic. Together, Herzberg’s and Maslow’s theories provide a comprehensive lens for understanding how institutional support, working conditions, and intrinsic rewards influenced workplace motivation in the Zambian health sector during an unprecedented public health emergency.

2.4 Objectives

This study was guided by the following objectives

• To identify the key motivation factors that influenced healthcare workers at Levy General Hospital to remain at the frontline in caring for COVID-19 patients despite associated risks.
• To determine the institutional and managerial support systems that enhanced healthcare workers’ productivity during the COVID-19 pandemic.
• To assess the current levels of motivation and performance among healthcare workers at Levy General Hospital.

3 Research Methodology:

A mixed-methods research design was adopted for this study. A mixed-methods approach integrates both quantitative and qualitative techniques to gain a comprehensive understanding of the phenomenon (Creswell, 2014). The population comprised frontline healthcare workers at Levy General Hospital who served during the COVID-19 pandemic. According to the hospital’s COVID-19 operational report, a core team of 40 frontline healthcare workers was established. A combination of purposive sampling and random sampling was used and quantitative data was collected through structured surveys and analyzed using statistical techniques such as descriptive statistics, cross-tabulations and qualitative was thematically analyzed using coding techniques to identify recurring themes.

4 Results and Findings

The findings of this study reveal key trends, opportunities, and challenges in the digital transformation of Islamic capital markets. Analysis of literature, case studies, and regulatory reports highlights the extent of digital adoption, its impact on market efficiency, investor participation, and regulatory compliance.

4.1 Key motivation factors that influenced healthcare workers at Levy General Hospital to remain at the frontline in caring for COVID-19 patients despite associated risks.

The statistical analysis of the survey data (n = 18) indicates that workplace-related motivational factors played a significant role in sustaining healthcare workers’ engagement during the COVID-19 pandemic at Levy Mwanawasa General Hospital. A majority of respondents (77.8%) either agreed or strongly agreed that the overall work environment contributed to their continued frontline engagement, suggesting a generally supportive institutional climate. Similarly, 72.2% of participants agreed or strongly agreed that management provided the necessary materials and support, highlighting the importance of logistical and managerial backing during the crisis.

However, perceptions of recognition for undertaking risky assignments were mixed, with 55.6% of respondents disagreeing or strongly disagreeing, indicating dissatisfaction with non-monetary appreciation mechanisms. In contrast, monetary motivation appeared to be a strong driver, as 77.8% of respondents agreed or strongly agreed that allowances, incentives, and other financial rewards attached to COVID-19–related work encouraged their continued service. The findings demonstrated that while a supportive work environment and material support were key motivators, financial incentives were more influential than recognition in sustaining frontline healthcare workers’ commitment during the pandemic.

Table 1: Factors that influenced healthcare workers at Levy General Hospital to remain at the frontline in caring for COVID-19 patients despite associated risks.

4.2 Institutional and managerial support systems that enhanced healthcare workers’ productivity during the COVID-19 pandemic.

The statistical analysis of institutional and managerial support systems enhancing healthcare workers’ productivity during the COVID-19 pandemic indicates clear variations in motivational factors among the 18 respondents. Recognition attached to undertaking the service emerged as the strongest motivator, with 100% (n = 18) rating it as highly motivating, highlighting its critical role in sustaining productivity during the crisis. Allowances were also perceived positively, as 72.2% (n = 13) reported them as highly motivating, although a notable proportion indicated a need for improvement (16.67%, n = 3), suggesting gaps in adequacy or consistency.

Pre-in-service training was generally viewed as motivating, with 50% (n = 9) rating it as motivating and 38.88% (n = 7) as highly motivating, though a small minority (11.1%, n = 2) felt it was insufficient. In contrast, attached possibilities for promotion showed mixed perceptions, with only 11.11% (n = 2) rating them as highly motivating, while 44.4% (n = 8) considered them merely motivating and 27.77% (n = 5) indicating a need for improvement, reflecting limited career progression opportunities during the pandemic. The findings revealed that non-financial incentives such as recognition were more consistently motivating than structural incentives like promotions, underscoring the importance of both immediate and long-term support mechanisms in healthcare settings.

Table 2: Institutional and managerial support systems that enhanced healthcare workers’ productivity during the COVID-19 pandemic.

4.3 To assess the current levels of motivation and performance among healthcare workers at Levy General Hospital

One of the frontline T1 indicated that:

“The entire work environment here at Levy Teaching Hospital feels like a family setup. The cooperation among colleagues gives us strength to continue working.”

Another frontline T2 also said that:

“Management has shown commitment in responding to our needs safety, fairness, and opportunities for growth. It motivates us to stay in the COVID-19 team.”

Frontline T5 stated that:

“Management through government aid and cooperating partners have deliberately allocated funds meant for allowances for COVID-19 frontline staffs, and them participating in the fight against this global pandemic comes with great recognition locally and internationally”.

4.4 Discussion

The study revealed that majority of respondents (77.8%) either agreed or strongly agreed that the overall work environment contributed to their continued frontline engagement, suggesting a generally supportive institutional climate. Similarly, 72.2% of participants agreed or strongly agreed that management provided the necessary materials and support, highlighting the importance of logistical and managerial backing during the crisis. In contrast, monetary motivation appeared to be a strong driver, as 77.8% of respondents agreed or strongly agreed that allowances, incentives, and other financial rewards attached to COVID-19–related work encouraged their continued service. The findings demonstrated that while a supportive work environment and material support were key motivators, financial incentives were more influential than recognition in sustaining frontline healthcare workers’ commitment during the pandemic.

Several empirical studies support these findings, showing that a supportive institutional climate, material and managerial backing, and financial incentives are key motivators for frontline healthcare workers during the COVID-19 pandemic. Morishita et al. (2022) found that a very high proportion of healthcare workers in Japan reported that financial incentives were necessary to maintain motivation while caring for COVID-19 patients. Similarly, a multi-country study in the Democratic Republic of Congo, Nigeria, Senegal, and Uganda reported that both financial rewards and non-financial workplace supports motivated health workers and sustained service delivery during the pandemic.

The study established that recognition attached to undertaking the service emerged as the strongest motivator, with 100% (n = 18) rating it as highly motivating. Allowances were also perceived positively, though gaps in adequacy and consistency remained. Training opportunities enhanced confidence and motivation, while limited promotion opportunities weakened long-term motivation. Overall, the findings confirm that recognition and immediate support mechanisms are more consistently motivating during health crises than structural incentives such as promotion.

The study highlighted that frontline health workers at Levy Teaching Hospital are strongly motivated by a supportive work environment characterized by teamwork, cooperation, and a family-like atmosphere. Visible management commitment to staff safety, fairness, professional growth, and the provision of allowances and recognition through government and partner support enhances morale and encourages continued participation in the COVID-19 response.

5 Conclusion

In conclusion, the study demonstrates that frontline healthcare workers at Levy Teaching Hospital are primarily motivated by a combination of intrinsic and extrinsic factors, with recognition for their service emerging as the most powerful driver, followed closely by financial incentives and supportive work environments. While allowances, pre-service training, and material support play important roles in sustaining engagement, opportunities for promotion were less influential, reflecting structural limitations during the pandemic. These findings support Herzberg’s Two-Factor Theory and other research, showing that immediate recognition, sufficient resources, and a teamwork-focused workplace are more important for keeping motivation during health crises than long-term career growth. Overall, a well-supported, safe, and appreciative work environment, coupled with timely financial and material incentives, is essential for sustaining frontline healthcare workers’ commitment and productivity during emergencies like COVID-19.

Implications for Practice

The following were the implications derived from the findings:

• The strong influence of allowances and other financial rewards indicates that health systems should ensure timely and adequate compensation for frontline workers during crises.
• Recognition emerged as the most motivating factor, suggesting that institutional acknowledgment of health workers’ efforts through awards, certificates, or public appreciation can significantly boost morale and productivity, even when resources are constrained.
• Pre-service and in-service training were shown to increase confidence and motivation. Health institutions should invest in continuous professional development to strengthen competence and commitment, especially during emergencies.

References

References

Blaauw, D., Ditlopo, P., & Rispel, L. C. (2013). Nursing education and health workforce challenges in South Africa. Human Resources for Health, 11(1), 1–10. https://doi.org/10.1186/1478-4491-11-1

Chileshe, R. (2018). Determinants of employee motivation in the public service: A case study of Zambia. Lusaka: University of Zambia Press.

Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). SAGE Publications.

Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01

Dieleman, M., Cuong, P. V., Anh, L. V., & Martineau, T. (2006). Identifying factors for job motivation of rural health workers in North Viet Nam. Human Resources for Health, 4(10), 1–11. https://doi.org/10.1186/1478-4491-4-10

Dowling, J., & Richardson, M. (1997). Motivation and performance management in healthcare. London: Health Services Management Centre.

Franco, L. M., Bennett, S., & Kanfer, R. (2002). Health sector reform and public sector health worker motivation: A conceptual framework. Social Science & Medicine, 54(8), 1255–1266. https://doi.org/10.1016/S0277-9536(01)00132-0

Gupta, N., & Mitra, A. (1998). Incentives and worker performance in public sector organizations. World Bank Policy Research Working Paper 1985.

Herzberg, F., Mausner, B., & Snyderman, B. B. (1959). The motivation to work. New York: John Wiley & Sons.

Jensen, M. C., & Meckling, W. H. (1976). Theory of the firm: Managerial behavior, agency costs, and ownership structure. Journal of Financial Economics, 3(4), 305–360. https://doi.org/10.1016/0304-405X(76)90026-X

Latham, G. P., & Pinder, C. C. (2005). Work motivation theory and research at the dawn of the twenty-first century. Annual Review of Psychology, 56, 485–516. https://doi.org/10.1146/annurev.psych.55.090902.142105

Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S., … & Yang, B. X. (2020). The experiences of healthcare providers during the COVID-19 crisis in China: A qualitative study. The Lancet Global Health, 8(6), e790–e798. https://doi.org/10.1016/S2214-109X(20)30204-7

Manongi, R., Marchant, T., & Bygbjerg, I. (2006). Improving motivation among primary health care workers in Tanzania: A health worker perspective. Human Resources for Health, 4(6), 1–9. https://doi.org/10.1186/1478-4491-4-6

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396. https://doi.org/10.1037/h0054346

Mathauer, I., & Imhoff, I. (2006). Health worker motivation in Africa: The role of non-financial incentives and human resource management tools. Human Resources for Health, 4(24), 1–13. https://doi.org/10.1186/1478-4491-4-24

Morishita, M., Takahashi, H., & Nakayama, T. (2022). Motivation and engagement of healthcare workers during the COVID-19 pandemic in Japan. BMC Health Services Research, 22, 115. https://doi.org/10.1186/s12913-022-07533-7

Nimusima, J., & Tumwine, S. (2016). Employee motivation and organizational performance in the public sector. Journal of Public Administration and Governance, 6(1), 23–37. https://doi.org/10.5296/jpag.v6i1.9265

Nyashanu, M., Pfende, F., & Ekpenyong, M. S. (2020). Triggers of stress and coping strategies among health workers during COVID-19 pandemic in Zimbabwe. BMC Health Services Research, 20, 1–11. https://doi.org/10.1186/s12913-020-05845-3

O’Donnell, M., & Shields, J. (2002). Employee motivation in public service organizations: A review of the literature. Australian Journal of Public Administration, 61(3), 14–26. https://doi.org/10.1111/1467-8500.00247

OECD. (2019). Public sector motivation: Understanding the drivers of employee engagement. OECD Publishing. https://doi.org/10.1787/9789264306185-en

Perry, J. L. (2010). Handbook of public sector motivation. Edward Elgar Publishing.

Redman, T., Snape, E., & Bamber, G. J. (2000). The effects of recognition and reward on motivation in the public sector. Public Administration, 78(1), 115–132. https://doi.org/10.1111/1467-9299.00185

Robbins, S. P., & Judge, T. A. (2019). Organizational behavior (18th ed.). Pearson.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68

Wright, B. E. (2001). Public-sector work motivation: A review of the current literature and a revised conceptual model. Journal of Public Administration Research and Theory, 11(4), 559–586. https://doi.org/10.1093/oxfordjournals.jpart.a003733