BackgroundMaternal and neonatal morbidity and mortality rates in the Democratic Republic of Congo (DRC) remain unacceptably high. The lack of empirical evidence on the capacity and performance of health facilities offering emergency obstetric and neonatal care (EmONC) is a central problem.MethodsThis study assessed the quality of EmONC provision across 63 healthcare facilities in Vanga Health Zone, Kwilu province, DRC.ResultsWe identified widespread infrastructural deficiencies, including no water sources in 61/63 facilities, no emergency transfer capability, and critically low bed capacity. Stock inventories showed that 38/52 categories assessed in facilities had poor availability of basic EmONC equipment, supplies and medications. The median number of nurses providing 24/7 care across all specialties in nurse-led facilities was four. Doctors were employed at 5/63 facilities (13 doctors total), none with postgraduate training. Signal function data revealed widespread failure to provide basic EmONC alongside dangerous practices including caesarean sections and blood transfusions performed without doctors, trained staff or essential equipment. Caseload data was near-identical across both collection periods in all 58 nurse-led facilities, possibly suggesting falsification linked to performance-based financing.ConclusionHealth facilities in Vanga Health Zone show inadequacies in all quality domains assessed and are unable to provide safe or acceptable EmONC. Women and newborns are suffering unnecessary harm due to system-level failings in resource allocation and governance.