Ashanti Region's maternal mortality crisis: one quarter of Ghana's deaths traced to health system gaps

Ghana's Ashanti Region is grappling with a severe maternal health emergency, accounting for nearly one-quarter of all maternal deaths across the country. Health authorities have now identified systemic delays in patient referral pathways to major tertiary facilities as a primary driver of the region's alarming mortality figures, raising urgent questions about healthcare infrastructure and resource allocation in the country's second-largest region.

The concentration of maternal deaths in Ashanti represents a significant public health challenge that extends beyond the region itself. With a population of over 10 million people and serving as Ghana's commercial and industrial hub, the Ashanti Region's health outcomes carry national implications for maternal mortality reduction efforts and the achievement of global health targets.

The referral system bottleneck

Late referrals to Komfo Anokye Teaching Hospital (KATH), the region's primary tertiary facility, have emerged as a critical factor in preventable deaths. When pregnant women or those experiencing obstetric complications face delays in reaching appropriate levels of care—whether due to distance, transportation challenges, or inadequate clinical decision-making at lower-level facilities—outcomes deteriorate rapidly. Maternal emergencies such as postpartum haemorrhage, preeclampsia, and sepsis require immediate specialist intervention, and delays of even hours can prove fatal.

The referral system weakness points to several interconnected issues: limited capacity at primary and secondary health facilities to manage complications, communication gaps between facilities, transportation barriers in rural and semi-rural areas, and potentially insufficient clinical training on when and how to refer patients urgently.

Why it matters for Ghana

Ghana has made progress on maternal health in recent decades, but progress has plateaued. The country's maternal mortality ratio remains unacceptably high relative to income level, and regional disparities underscore how uneven health system strengthening has been across different areas. Ashanti's crisis suggests that investment in health infrastructure has not kept pace with population growth and healthcare demand in the region.

The findings also highlight the importance of the three delays framework in maternal health—delay in deciding to seek care, delay in reaching a facility, and delay in receiving appropriate treatment. While Ashanti's immediate challenge appears centred on the third delay and referral systems, addressing the underlying causes will require multi-level interventions:

• Strengthening diagnostic and management capacity at district and municipal health facilities to reduce unnecessary referrals and handle stabilisable cases locally
• Improving transportation networks and ambulance services for emergency referrals, particularly in remote communities
• Enhancing communication systems between facilities to expedite referral documentation and clinical handovers
• Investing in maternal health training for health workers across all facility levels
• Addressing supply chain issues for essential obstetric drugs and equipment

The scale of Ashanti's burden also raises questions about resource allocation within the national health budget. If one region accounts for 25% of national maternal deaths, a proportionate increase in health spending and targeted interventions there could yield significant reductions in national maternal mortality figures.

Health authorities must act swiftly to diagnose root causes specific to each facility and community within Ashanti, and design context-appropriate solutions. Without urgent intervention, maternal mortality in the region will continue to claim preventable lives and undermine national health development goals.