The Republic of Moldova is the first country in the WHO European Region to develop a dedicated Health Nexus Roadmap and Operational Plan for the transition of refugee health support from emergency humanitarian assistance towards sustainable national arrangements. This provides the Region with a concrete example of how humanitarian and development partners can work together within a health-sector framework led by national institutions.
Innovation lies in planning humanitarian support and development investment together, with shared outcomes, financing pathways, institutional responsibilities and timelines. Immediate assistance can protect access to health care while legal reforms, public financing and service capacity are developed. For the Republic of Moldova, this makes it possible to plan the transition before humanitarian funding ends, identify gaps requiring continued support and direct new investment towards the national institutions that will sustain care.
“Our priority is to ensure continuity of care while strengthening the health system for the future. The Health Nexus approach helps us integrate the needs of refugees into national health planning in a way that is sustainable and benefits the health system as a whole,” said Iuliana Garam, Secretary of State at the Ministry of Health.
Building on the Republic of Moldova’s response
Since the start of the war in Ukraine in 2022, the Republic of Moldova has opened its doors to people fleeing the war. More than 4 years later, around 100 000 refugees from Ukraine remain in the country, representing approximately 5% of the Republic of Moldova’s population. Around 60 000 hold temporary protection status. Most are women and children. Many families need ongoing care for chronic conditions, support for older relatives or access to rehabilitation. Their health needs extend well beyond the emergency that brought them to the country.
From the beginning, the Republic of Moldova’s response was anchored in its existing health system. Despite pressure on public resources and capacity constraints within the health system, national institutions remained the main providers of health care for refugees. The introduction of temporary protection in March 2023 provided a clear legal framework for access to essential services, including emergency, primary and specialized health care, as well as vaccination, ensuring that Ukrainian refugees have access to the same health coverage as the Moldovan population.
Government institutions, WHO, United Nations agencies, nongovernmental organizations and other partners worked together to maintain access and address gaps. The WHO Country Office in the Republic of Moldova supported coordination and pooled financing through a Multi-Partner Trust Fund, channelling resources through the National Health Insurance Company (Compania Națională de Asigurări în Medicină, CNAM) to help cover the costs for individuals of care delivered by public providers. Where gaps remained, partners provided targeted support, including palliative care, mobile health services in rural areas and assistive technologies.
Regular health-sector coordination, led by the Ministry of Health with WHO support, helped partners and United Nations agencies identify needs, reduce duplication and direct resources where they were most needed. This experience created a strong foundation for the next stage: ensuring that access to health care can continue as humanitarian funding declines.
Planning the transition
With the Refugee Response Plan approaching its planned conclusion in 2026, the Republic of Moldova needed to address a central question: how can essential services continue as temporary humanitarian financing decreases?
The challenge is closely linked to broader health-system pressures, including health workforce shortages and limited access to specialist services, particularly in rural areas. A transition therefore requires not simply replacing one source of funding with another but strengthening the national mechanisms through which services are financed and delivered.
European Union (EU) funding has been instrumental in advancing support to refugees. As part of the EU project, “Health action for refugee response sustainability”, WHO has continued to work closely with the Ministry of Health and partners to develop a Health Nexus approach adapted to this context. Under this model, humanitarian assistance continues to address immediate needs, while development investment supports the financing, workforce capacity and institutional arrangements required for longer-term sustainability.
“The transition is about making financing more predictable and ensuring that people can continue to receive the services they need through the national system. Our objective is to move towards sustainable mechanisms while maintaining financial protection and continuity of care,” said Andrei Uncuța, Director General of CNAM.
Sustainable services
A dedicated Health Nexus workshop, held in Chișinău on 12 March 2026, brought together the Ministry of Health, Ministry of Internal Affairs, CNAM, the European Union, development partners and donors, including Switzerland, United Nations agencies, health institutions, nongovernmental organizations and refugee-led organizations.
Drawing on evidence and experience accumulated since 2022, participants identified priorities for sustainable financing, essential health services, workforce capacity, coordination and the protection of vulnerable populations. These consultations informed the Health Nexus Roadmap 2026–2030 and its Operational Plan.
The Roadmap is aligned with the Republic of Moldova’s National Programme on the Phased Integration of Foreigners, established through Government Decision No. 285/2025, connecting refugee health priorities with the country’s wider policy and development agenda.
A practical model
The Roadmap and Operational Plan established a common framework for action across 6 interconnected areas: financing, essential health services, health workforce and quality of care, coordination, emergency preparedness, and health information and digital systems.
For patients, this should mean clearer pathways to health coverage, better information about available services and more reliable referral mechanisms. The Operational Plan addresses insurance options for eligible people without formal employment and appropriate public support for those unable to contribute.
For health-care providers, it sets out a pathway towards more predictable financing for services currently dependent on humanitarian support, while addressing capacity constraints through specialist outreach, support to rural health workers and remote clinical advice.
“The Health Nexus is ultimately about continuity: ensuring that the progress achieved during the emergency response is not lost as humanitarian assistance decreases. The Republic of Moldova is showing how national leadership, humanitarian support and development investment can be brought together to strengthen services for refugees while building a more resilient health system for everyone,” said Dr Vitalii Stetsyk, Lead, Health and Nutrition Working Group, WHO Country Office in the Republic of Moldova.
The Republic of Moldova’s approach offers a practical model for countries hosting prolonged displaced populations. Rather than treating the humanitarian response and health-system development as separate processes, the Health Nexus connects them in an innovative way through one nationally led framework and more sustainable health services – for refugees and host communities.