A system for monitoring and responding to excess mortality in a health deprived setting of northern Ghana

There is ample evidence that high neonatal and maternal mortality remain as the greatest challenges to health development in rural Africa. Moreover, clinical strategies and health modalities for addressing excess mortality are also well developed and widely disseminated. Less is known, however, about practical organizational strategies for addressing the excess perinatal mortality in rural remote localities of sub-Saharan Africa. This paper reports on a low cost, replicable, and sustainable system of risk surveillance, and action that has identified priority perinatal service problems, fostered rapid strategic planning, and catalyzed a comprehensive program of emergency management training for frontline workers, referral systems development, and quality assurance intervention at referral service points. A pilot project, regional training program, and evaluation strategy are reviewed. Interventions are focused on immediate post-delivery monitoring and referral, kangaroo mother care, resuscitation training and action, the management of hemorrhaging, and other low cost and productive actions are reviewed and discussed. Taken as a package of interventions, undergoing implementation in Ghana's three poorest and most remote districts, represents a model for reducing the burden of disease associated with delivery and immediate post-delivery period.