Background: A referral system is an essential component in healthcare. The unpredictable nature of any pregnancy and the potential for life-threatening complications necessitate timely and effective referral mechanisms to ensure access to appropriate emergency obstetric care. An optimal obstetric referral system reduces delays and ensures timely access to appropriate care, leading to a reduction in pregnancy and childbirth complications. However, weaknesses in transport and communication systems, including health infrastructure often compromise the provision of quality obstetric care. The study aimed to assess the referral process for emergency obstetric care in primary level facilities as well as the availability of essential supplies for EmOC. Methods: The study used a cross-sectional design. The study was conducted between August and December 2022, targeting all healthcare workers working in obstetric units in Level 3 and 4 hospitals. Cochran’s formula was used to estimate the sample size (n =151). Stratified random sampling was used to select study participants. An interviewer-administered structured questionnaire and an observation checklist were used to collect data. The data was entered into SPSS v25 for analysis and analysed using descriptive and inferential statistics as applicable. Findings: Most of the respondents were aged between 30-39 years (54.0%), held a diploma education (88.2%), were nurses/midwives (81.4%) and were from Level 3 facilities (55.7%). Over 98% of the respondents agreed that EMoC referral is a common occurrence in their facilities and 96.3% were aware of obstetric signal functions. Effective communication and transport (linear regression coefficient, T=3.24, p=0.001), healthcare workers' perceived competence on the use of signal functions (linear regression coefficient, T=7.15, p=0.003), and the availability of supplies and equipment were strongly associated with the provision of quality EmOC services during the referral process (Chi-s