Article Text

Download PDFPDF

Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries
  1. Steeve Ebener1,
  2. Karin Stenberg2,
  3. Michel Brun3,
  4. Jean-Pierre Monet3,
  5. Nicolas Ray4,
  6. Howard Lawrence Sobel5,
  7. Nathalie Roos6,
  8. Patrick Gault7,
  9. Claudia Morrissey Conlon8,
  10. Patsy Bailey9,
  11. Allisyn C Moran8,
  12. Leopold Ouedraogo10,
  13. Jacqueline F Kitong11,
  14. Eunyoung Ko12,
  15. Djenaba Sanon13,
  16. Farouk M Jega14,
  17. Olajumoke Azogu14,
  18. Boureima Ouedraogo15,
  19. Chidude Osakwe16,
  20. Harriet Chimwemwe Chanza17,
  21. Mona Steffen4,
  22. Imed Ben Hamadi18,
  23. Hayat Tib18,
  24. Ahmed Haj Asaad18,
  25. Tessa Tan Torres2
  1. 1Health GeoLab Collaborative, Manila, Philippines
  2. 2WHO Headquarters, Department of Health Systems Governance and Financing (HGF), Geneva, Switzerland
  3. 3UNFPA, Technical Division, New York City, New York, USA
  4. 4University of Geneva, Institute of Global Health& Institute for Environmental Sciences, GeoHealth group, Geneva, Switzerland
  5. 5WHO Regional Office for Western Pacific Region, Manila, Philippines
  6. 6WHO Headquarters, Department of Maternal, Newborn, Child and Adolescent Health (MCA), Geneva, Switzerland
  7. 7Freedom Consulting Group, Columbia, Maryland, USA
  8. 8USAID, Washington, District of Columbia, USA
  9. 9FHI 360, Durham, North Carolina, USA
  10. 10WHO Regional Office for Africa, Brazzaville, Congo
  11. 11WHO Country Office, Manila, Philippines
  12. 12WHO Country Office, Vientiane, Lao PDR
  13. 13Ministry of Health, Ouagadougou, Burkina Faso
  14. 14Pathfinder International, Abuja, Nigeria
  15. 15Direction générale des études et des statistiques sectorielles, Ouagadougou, Burkina Faso
  16. 16Pathfinder International, Watertown, New York, USA
  17. 17WHO Country Office, Lilongwe, Malawi
  18. 18Geo Expertise, Geneva, Switzerland
  1. Correspondence to Dr Steeve Ebener; steeve.ebener{at}


Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

  • emergency obstetric and newborn care
  • physical accessibility
  • universal health coverage
  • sustainable development goals

This is an Open Access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from


  • Handling editor Seye Abimbola

  • Contributors SE conceptualised the paper, designed the structure of the paper, and was the lead for research and writing of all sections. CMC, HLS, J-PM, KS, MB, NaR and NiR were involved in conceptualising the paper, provided research inputs and commented on the revisions. TTT was involved in conceptualising the paper. AHA, BO, CO, DS, EK, FMJ, HCC, HT, IBH, LO, MS, PG and OA provided research and writing inputs for the ‘Empirical applications of the indicators’ section. ACM, JFK and PEB were involved in revising the manuscript. All authors read and approved the final manuscript.

  • Funding Financial support was provided by the Government of Norway for the implementation of the projects in Burkina Faso, Cambodia, Laos and Malawi. GIS analysis of SMGL facilities/data in Nigeria was funded by Merck for Mothers.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.