EmONC levels of care

Basic EmONC is a level of facilities that are staffed, equipped, and supported to identify and manage (including either definitively treating or stabilizing for referral) many obstetric and newborn complications that occur. In most countries these are a sub-set of the facilities generically called “health centers” that most often do not have the capability to provide surgery, blood transfusion and more specialized inpatient newborn care services.

The word “basic” is perhaps a misnomer and misleading for some,¹ because these are not crude or minimal facilities. Rather, they are sophisticated medical centers staffed by skilled personnel, often led by midwives, in sufficient number to ensure 24h/7d services, who are trained in the appropriate competencies to identify, manage and refer, as needed, women and newborns with complications, as well as to conduct routine deliveries and deliver essential newborn care. Typically, they will have a basic laboratory, pharmacy, and sterilization for infection prevention. More information on the duties, structure, and resources of a Basic EmONC facility can be found elsewhere.²

Basic EmONC facilities provide the opportunity for women to give birth closer to home but still be in facilities that are equipped to quickly respond to emergencies. They also provide an alternative setting for women who don’t want to give birth in large hospitals. In well-planned systems, Basic EmONC facilities can help decongest higher levels of care (i.e., Comprehensive EmONC) by resolving many of the complications that do not require surgery, blood or care in a special newborn care unit or neonatal intensive care unit.

See signal functions corresponding to Basic level of care.

For some obstetric complications, surgery or blood transfusion may be necessary and in virtually every system, these functions are delivered in facilities labelled as “hospitals,” which have surgical theatres and blood transfusion capacity (e.g., laboratories, blood banks). Similarly, some small and sick newborns require specially trained staff in a dedicated inpatient neonatal unit equipped to provide care for babies requiring thermal care, feeding and breathing support, and care for common neonatal conditions, including infections and jaundice. In the EmONC Framework, facilities that can provide such services are called Comprehensive EmONC facilities.

See signal functions corresponding to Comprehensive level of care.

The Intensive EmONC level is established in a small number of facilities, mostly teaching and regional hospitals in urban areas, that provide intensive care for very sick newborns in a Newborn Intensive Care Unit (NICU). This level of facility is usually defined by its capacity to provide invasive mechanical ventilation through intubation, which requires the highest level of supportive care. Such hospitals likely will also have intensive care units for adults, and so the rare woman experiencing a life-threatening obstetric complication that cannot be handled at a lower-level hospital or health center and requires intensive level organ support to survive, can be managed in an adult intensive care unit.

See signal functions corresponding to Intensive level of care.