Scaling emergency care capacity during concurrent public health and humanitarian crises: outcomes of WHO-ICRC basic emergency care course implementation in the Republic of Moldova.

INTRODUCTION: The Republic of Moldova, an upper-middle-income nation in Eastern Europe, has encountered overlapping public health and humanitarian challenges that have tested the resilience of its health system. Following the COVID-19 pandemic and 2022 influx of refugees from neighbouring Ukraine, the Ministry of Health (MoH) identified an urgent need to upskill healthcare providers in emergency care. The World Health Organization-International Committee of the Red Cross Basic Emergency Care (BEC) course was selected as a rapid solution to train a range of providers in managing acute patients. This study assessed BEC's effects on emergency care knowledge and confidence in Moldova. METHODS: From February 2023 to December 2024, 15 BEC courses were taught in Moldova. Participants completed pre- and post-course knowledge tests, confidence self-assessments, and feedback forms. Quantitative scores were assessed using descriptive statistics and nonparametric testing, and qualitative responses were analysed thematically. RESULTS: Of 371 enrolled participants, 312 (84%) completed all course requirements. Post-course knowledge scores were significantly higher than pre-course (mean score: +20.2%, p < 0.001). Self-reports also improved, with mean scores (ranging from 1 - least - to 4 - most) increasing from 1.85 (SD: 0.91) to 2.17 (SD: 0.67) for confidence (p < 0.001) and 1.58 (SD: 0.79) to 2.07 (SD: 0.61) for competence (p < 0.001). Most (89%) found the course highly relevant to their work and rated instructors as excellent (97%). Participants valued the symptom-based approach, hands-on simulations, short course duration, and interactive teaching, while suggesting more time for hands-on skills practice. CONCLUSION: National BEC implementation in Moldova showed that a standardized short course can generate significant gains in emergency care knowledge and confidence across diverse provider cadres in a matter of days. Participants gained significant emergency care knowledge and confidence, even though the healthcare system was under immense strain at the time of implementation. The rollout's decentralized delivery and high acceptability underscore its potential for national scalability and integration into existing preparedness frameworks. Moldova's experience demonstrates how targeted education can strengthen surge capacity and sustainably contribute to resilient health systems, even amid crises.