Re-visioning EmONC

Re-Visioning EmONC was a 5-year (2020-2024) joint project of AMDD, WHO, UNFPA, UNICEF and the London School of Hygiene and Tropical Medicine (LSHTM).  The goal of the project was to review, rethink, and revise the guidance on planning and monitoring EmONC that had been in use for the prior 25 years (1997, 2009). 

The revised EmONC Framework together with guidance and tools for adapting and using it can be found at www.emonc.org.  A description of the process used to develop the revised framework and an explanation of the evidence base is included on the emonc.org web site under Tools and Resources.

Over the course of the project, multiple working papers and peer-reviewed articles were generated.  We gather all of them here to provide access to the work of the project.

The EmONC Framework at www.emonc.org is intended to be a living document that can be updated as new norms or measures are established.

We welcome comments, questions, or requests for technical assistance on any aspect of the Framework.  Please contact AMDD at amdd@columbia.edu.

Materials generated by this project (note the following is under construction and some links may not be available): 

Human-centered design (HCD) country case studies 

Bangladesh report: Chowdhury ME, Khan R, Soltana N, Alam F, Jahan SA, Shaheen AR, Afsana K. Re-visioning emergency obstetric and newborn care (EmONC) framework: Bangladesh case study (Executive summary). Dhaka: icddr,b and Averting Maternal Death and Disability; 2023. 

Malawi report: Chodzaza E, Kamanga M, Zimba C, Potolani E. Re-visioning emergency obstetric and newborn care: The Malawi study report. Blantyre: Kamuzu University of Health Sciences (KUHeS) and Averting Maternal Death and Disability; 2023. 

Senegal report: Dieng T, Moreira I, Faye S. Project de révision des indicateurs des soins obstétricaux et néonataux d’urgence: Étude de cas du Sénégal. Dakar, Sénégal: Regional Center for Training and Research in Reproductive Health and Averting Maternal Death and Disability; 2023. 

EmONC Signal Functions 

Moxon SG, Balakrishnan SS, Penn-Kekana L, Sharma S, Talbott J, Campbell OMR, Freedman L. Evolving narratives on signal functions for monitoring maternal and newborn health services: A meta-narrative inspired review. Social Science & Medicine. 2024;352:116980. 

Moxon SG, Wharton-Smith A, Sharma S, Aluvaala J, Campbell OMR, Gupta G, Lobis S, Warthin C, Penn-Kekana L, Freedman LP; Delphi panel on EmONC signal functions and levels of care. A Delphi process to build consensus on revised Emergency Obstetric and Newborn Care (EmONC) signal functions and levels of care. PLOS One. 2025;20(9):e0331684. 

Moxon SG & Wharton-Smith A. Delphi study on obstetric and newborn care signal functions: Summary report. Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Project; April 2023. 

EmONC Levels of Care 

Mackin S, Day LT, Dekker C, Gouse I, Maina M, Aluvaala J, Moran A; Revisioning Emergency Obstetric and Newborn Care (EmONC) levels-of-care workstream. Levels of care for maternal and neonatal healthcare: A scoping review. Journal of Global Health. 2026;16:04035. 

Maina M. Bypassing of care around the time of birth for women and newborns: to what extent and why do women and newborns bypass care around the time of delivery in low and middle-income countries? Presentation to Re-visioning EmONC Steering Committee (pages 8-28), 15 June 2022. Averting Maternal Death and Disability; 2022. 

Human Resources 

Stones W & Nair A. Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator. Frontiers in Global Women’s Health. 2023;4:1028273. 

Jolivet RR, Munson E, Gouse I, Chodzaza E, Chowdhury ME, Dieng T, Lobis S, Moreira I, Ramsey K, Warthin C, Freedman L. The development of proxy indicators to measure workforce well-being in emergency obstetric and neonatal care settings. Journal of Global Health. 2025;15:04223. 

Emergency Referral 

Lydon MM, Gupta P, Acker P, Penn-Kekana L, Keyes EB. Development of an indicator to measure emergency interfacility referral readiness for maternal and newborn care at national and sub-national levels. SSM - Health Systems. 2025;5:100137. 

Quality of Care 

Wang D, Sacks E, Odiase OJ, Kapula N, Sarakki A, Munson E, Afulani PA, Requejo J; Re-visioning Emergency Obstetric and Newborn Care (EmONC) quality of care workstream. A scoping review, mapping, and prioritisation process for emergency obstetric and neonatal quality of care indicators: focus on provision and experience of care. Journal of Global Health. 2023;13:04092. 

Kapula N, Sacks E, Wang DT, Odiase O, Requejo J, Afulani PA; Re-visioning EmONC Quality of Care Workgroup. Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reproductive Health. 2023;20(1):7. 

Sacks E. Togetherness and “zero separation” concept note. Averting Maternal Death and Disability; 2023. 

Munson E. Patient safety and provider experience. (Summary of rapid review.) 26 April 2022. Averting Maternal Death and Disability; 2022. 

Briefs on 2009 EmOC Indicators 

Averting Maternal Death and Disability. Indicator 1: Availability of emergency obstetric care (EmOC). 2022. 

Averting Maternal Death and Disability. Indicator 2: Geographical distribution of emergency obstetric care (EmOC) facilities. 2022. 

Averting Maternal Death and Disability. Indicator 3: Proportion of births in EmONC facilities. 2022. 

Averting Maternal Death and Disability. Indicator 4: Met need for EmOC. 2022. 

Averting Maternal Death and Disability. Indicator 5: Cesarean deliveries as a proportion of all births. 2022. 

Averting Maternal Death and Disability. Indicator 6: Direct obstetric case fatality rate. 2022. 

Averting Maternal Death and Disability. Indicator 7: Intrapartum stillbirth and very early neonatal death rate. 2022. 

Averting Maternal Death and Disability. Indicator 8: Proportion of [maternal] deaths due to indirect causes in EmOC facilities. 2022.