Table 3.

Summary table of key geographical findings

Author(s)	Year	Country of study	Indicators assessed	Scale of study	Number of facilities studied	Percentage of total facilities surveyed	Type of facility studied	Key geographical findings presented
Kongnyuy et al [23]	2009	Malawi	Indicator 1-6	Sub-national	73	100% of all facilities within the selected geographical area.	Public, private and mission facilities	There was no equitable distribution as some rural areas are not covered. Most of the Comprehensive EmOC* facilities were located in the central area of Lilongwe District and three were actually in or near the capital city.
Admasu, Haile-Mariam & Bailey [25]	2011	Ethiopia	All indicators	National	795	98.6% of all facilities within the selected geographical area.	Public, private and mission facilities	In Ethiopia, facilities were concentrated in the centre of the country, leaving peripheral areas underserved. Only 1 (Harari) of 11 regions met the goal of 5 per 500 000. The most populous regions of Oromiya, Amhara, and Southern Nations, Nationalities, and Peoples’ Region had only 0.4, 0.4, and 0.5 EmOC facilities per 500 000, respectively.
Bailey et al [8]	2011	Ethiopia	Indicator 1 & 2	Sub-national	249	31% of all facilities within the selected geographical area.	Public, private and mission facilities	Approximately 70% of the population of Tigray and Amhara regions is served by facilities that are within a 2-h transfer time to a hospital with obstetric surgery. By adding vehicles and communication capability, this percentage increased to 83%. In a second scenario, upgrading 7 strategically located facilities changed the configuration of the referral networks, and the percentage increased to 80%. By combining the two strategies, 90% of the population would be served by midlevel facilities within 2 h of obstetric surgery. The mean travel time from midlevel facilities to surgical facilities would be reduced from 121 to 64 min in the scenario combining the 2 interventions.
Gabrysch et al [22]	2011	Zambia	Indicator 1 & 2	National	1370	100% public hospitals. Percentage of private hospitals surveyed not reported.	Public, private and mission facilities	Geographic access to EmOC services in rural areas was low; in most provinces, less than 25% of the population lived within 15 km of an EmOC facility
Oyerinde et al [24]	2011	Sierra Leone	Indicator 1-6	National	145	100% of all hospitals. 33% of community health clinics and four MCH posts per district.	Public, private and mission facilities	Eastern Province and Southern Province had the lowest coverage. There was an abundance of Comprehensive EmOC facilities in Western Area District (where the capital city, Freetown, is located).
Gething et al [19]	2012	Ghana	Indicator 1 & 2	National	1864	100% of all facilities within the selected geographical area.	Public, private and mission facilities	A third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities. In the most remote regions these figures rose to 63% and 81%, respectively.
Sudhof et l. [9]	2012	Rwanda	Indicator 1 & 2	Sub-national	9	100% of all facilities within the selected geographical area.	Could not tell	The lowest Caesarean section rates were found in the more remote part of the hospital catchment area.
Echoka et al [18]	2013	Kenya	Indicator 1, 2 & 5	Sub-national	40	100% of all facilities within the selected geographical area.	Public, private and mission facilities	All the three hospitals offering Comprehensive EmOC services and one of the two health centres offering BEmOC services were located in Malindi Division, the main urban centre in the district. The area is served by a relatively well functioning public transport system and adequate roads. The two vast and remote divisions, Langobaya and Marafa, were not served by any EmOC facility and are not connected to any major trunk road with regular public transport. Average distance to the nearest EmOC facility was 5kms and 30kms in the urban and rural areas respectively.
Compaoré et al [26]	2014	Burkina Faso	Indicator 1 & 2	National	52	100% of public hospitals. No private hospitals included.	Public hospitals only	Map of georeferenced facilities shows a relatively good geographical distribution of both regional and district hospitals within the country, very few of which are ready to provide Comprehensive EmOC.
Bosomprah et al [17]	2016	Ghana	Indicator 1 & 2	National	1159	91% of all facilities within the selected geographical area.	Public and private facilities	Greater Accra and Ashanti recorded a shortfall of 28 and 26 facilities, respectively, whereas Upper East and Upper West had a shortfall of only 7 and 3, respectively. Subnational analyses based on estimated total pregnancies in each district revealed a pattern of inequity in service provision across the country.
Baguiya et al [16]	2016	Guinea	All indicators	National	502	100% of all facilities within the selected geographical area.	Public and private facilities	There was a scarce and unequal distribution of such facilities. Fully functioning facilities were not equally distributed across regions. Boké and Conakry had four each, whereas Kindia and Mamou had none.
Kouanda et al [27]	2016	Burkina Faso	All indicators	National	1628 (2010) and 812 (2014)	82% (2010) of facilities at national level. Not estimated in the 2014 survey.	Public, private and mission facilities	There was wide regional disparity in both 2010 and 2014 on the availability of functional EmONC health facilities.
Fakih et al [21]	2016	Tanzania	Indicator 1-7	Sub-national	79	100% of all hospitals. 38% of Primary Health Care Units (PHCUs) across all districts.	Public and private facilities	The distribution of Basic EmOC and Comprehensive EmOC facilities varied across Zanzibar. Basic EmOC facilities were available in North Pemba and South Pemba regions, as well as West Urban regions. Comprehensive EmOC facilities were mainly concentrated in Urban West (Unguja); North Pemba and South Pemba regions.
Tembo et al [28]	2017	Zambia	Indicator 1 & 2	Sub-national	35	Could not tell	Public and private facilities	18 Basic EmOC per 500 000 population; 5 Comprehensive EmOC per 500 000 population.
Chen et al [20]	2017	Tanzania	Indicator 1 & 2	Sub-national	127	Could not tell	Could not tell	Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmOC facilities within 2 h on foot, 33% in areas that can be reached within 2 h only by motorized vehicles, and 32% where it is impossible to reach EmOC facilities within 2 h. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles.

EmOC – emergency obstetric care