Emergency obstetric and newborn care availability, utilization and referral capabilities in Zambia using a national facility census

Abstract

Abstract Introduction Improving maternal and newborn health remains a global priority. Despite an increase in the number of health facilities providing childbirth services, not all can perform basic or comprehensive emergency obstetric and newborn care (EmONC) to avert maternal and neonatal deaths. This study assessed the availability of EmONC in government-owned health facilities, the distribution of births at facilities providing EmONC, and travel times from non-CEmONC facilities to referral facilities equipped to perform Caesarean sections and blood transfusions in Zambia. Methods The analysis used 2022 data on 543,999 institutional births across 2204 health facilities and childbirth service availability data, including EmONC signal functions, from a national facility census to estimate the probability of delivering in an EmONC facility, map the spread of EmONC facilities using QGIS, and estimate motorised travel time from non-CEmONC facilities to the nearest referral facility performing both Caesarean section and blood transfusion using the cost-friction surface approach. Results In 2021/2022, 90 out of 123 secondary health facilities (73.2%) performed all nine comprehensive EmONC signal functions while 387 out of 2204 (4.2%) performed the seven basic EmONC signal functions. Of all institutional births, 36.4% were in facilities able to provide CEmONC, 11.9% in BEmONC facilities, and 40.7% in facilities providing only routine childbirth services. Although 88.7% of non-CEmONC were located within two hours of a referral facility performing both Caesarean section and blood transfusion, 37.3% lacked a functional ambulance to transport women and newborns to a CEmONC facility in emergencies. Conclusion Our findings show that while CEmONC signal functions are available in most secondary health facilities, the overall availability of either Basic or Comprehensive EmONC remains low, with more than half of the deliveries occurring in facilities with limited emergency obstetric capabilities. The low availability of ambulances further increases the risk that women in need of emergency inter-facility referral will not receive timely and appropriate care. There is a need to better equip health facilities to perform their designated level of EmONC signal functions and transport emergency cases to CEmONC facilities when needed to further reduce maternal and neonatal mortality and ensure equitable distribution of EmONC in Zambia.

The authors' abstract, as published at the source. BMC Pregnancy and Childbirth, 2026 · DOI ↗