Maternal mortality is decreasing globally, but not fast enough and with critical inequalities across the regions of the world. Dying while giving birth is not only an unacceptable human right violation but also a violence against women in times where the majority of the maternal deaths are preventable if appropriate healthcare is provided.

Based on field experiences and on a close collaborative work with UNFPA’s country offices and regional offices, the Maternal and Newborn Health Thematic Fund (MHTF) team of UNFPA’s Technical Division has developed an approach for countries to identify their national network of referral (EmONC) health facilities, implement interventions to upgrade them in maternity units with quality obstetric and newborn care, and monitor the development of the network to ensure the provision of quality MNH care.

The proposed approach uses the Geographic Information System (GIS) technology to map the EmONC health facilities and maximize the proportion of the population accessing the closest EmONC health facility within 1 or 2 hours of travel time. This technology became one of the cornerstones of UNFPA’s approach to EmONC, which is already implemented in 11 countries and in more countries from 2020.

This manual also revisits the concept of EmONC health facilities and EmONC indicators proposed in 2009. It analyses the role of the EmONC health facilities in the health system and more precisely describes the role, the infrastructure, and the resources of a basic EmONC health facility (B EmONC) and the way to articulate it with the Comprehensive EmONC health facility (C EmONC) and the other maternities (non EmONC health facilities). It also highlights the critical role of the midwives in the EmONC facilities.