With timely access to skilled care, most maternal and newborn deaths in low-income countries are preventable. Reaching the right care at the right time remains a challenge, especially when emergency interfacility referral is required to manage complications.Referral is a critical component of high-quality health systems that requires many elements within and outside facilities to function properly. This panel brings together implementers and researchers to describe a consolidated conceptual framework and a proposed monitoring framework for emergency referral system performance, aimed to guide health planners and policymakers toward improved system functioning.Panelists will summarize current evidence around emergency referral systems, including a multi-country analysis of referral system performance, and share perspectives of designing and managing referral systems in different contexts. The aim is to generate discussion of practical approaches to design, implement, and continuously monitor these complex systems to enable timely access to life-saving services in different contexts.The conceptual framework was developed by members of the management committee for the global Community of Practice for Transport and Referral, based at the London School of Hygiene and Tropical Medicine. The multi-country analysis was conducted by FHI 360 with funding from the Averting Maternal Death and Disability Program at Columbia University. Implementation perspectives come from a U.S. Agency for International Development (USAID)-funded project in Mozambique and an emergency management institute in India.