title: Spatial distribution of emergency obstetric and newborn care services in Ghana: Using the evidence to plan interventions.
abstract: OBJECTIVE
  To provide clear policy directions for gaps in the provision of signal function services and sub-regions requiring priority attention using data from the 2010 Ghana Emergency Obstetric and Newborn Care (EmONC) survey.
  
  
  METHODS
  Using 2010 survey data, the fraction of facilities with only one or two signal functions missing was calculated for each facility type and EmONC designation. Thematic maps were used to provide insight into inequities in service provision.
  
  
  RESULTS
  Of 1159 maternity facilities, 89 provided all the necessary basic or comprehensive EmONC signal functions 3months prior to the 2010 survey. Only 21% of facility-based births were in fully functioning EmONC facilities, but an additional 30% occurred in facilities missing one or two basic signal functions-most often assisted vaginal delivery and removal of retained products. Tackling these missing signal functions would extend births taking place in fully functioning facilities to over 50%. Subnational analyses based on estimated total pregnancies in each district revealed a pattern of inequity in service provision across the country.
  
  
  CONCLUSIONS
  Upgrading facilities missing only one or two signal functions will allow Ghana to meet international standards for availability of EmONC services. Reducing maternal deaths will require high national priority given to addressing inequities in the distribution of EmONC services.
authors.affiliation: Evidence for Action, Ghana and School of Public Health, University of Ghana, Legon, Accra, Ghana. Electronic address: sbosomprah@gmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Department of Geography and Environment, University of Southampton, Southampton, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Flowminder Foundation, Stockholm, Sweden.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.affiliation: Evidence for Action, Ghana and School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Winfred
authors.initials: W
authors.lastname: Dotse-Gborgbortsi
authors.affiliation: Family Health Division, Ghana Health Service, Accra, Ghana.
authors.forename: Patrick
authors.initials: P
authors.lastname: Aboagye
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Matthews
mesh_terms: D036861:Delivery, Obstetric / Q000592:standards / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards / Q000600:supply & distribution*; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000592:standards / Q000600:supply & distribution*; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000592:standards / Q000600:supply & distribution*; D011247:Pregnancy; D062206:Spatial Analysis
keywords: Emergency obstetric and newborn care (EmONC); Geospatial analysis; Ghana; Maternal mortality; Needs assessment; Signal functions