Ž . International Journal of Gynecology & Obstetrics 59 Suppl. 2 1997 S83S90 Upgrading obstetric care at the health center level, Juaben, Ghana J.O. Djan a,  , S. Kyei-Faried b , S. Twum b , J.B.O. Danquah b , M. Ofori b , E.N.L. Browne a , Ž . The Kumasi PMM Team a School of Medical Sciences, Ministry of Health, Kumasi, Ghana b Ministry of Health, Kumasi, Ghana Abstract Ž . Preliminary studies: Inventory and observations at Juaben Teaching Health Center JTHC revealed an inability to treat obstetric complications. Women with complications needed to be referred to other institutions, resulting in delays. Interentions: During 1993 and 1994, an operating theater and blood bank were established and equipped, the maternity refurbished, and a revolving drug fund created. A physician was posted and trained in obstetrics, and midwives were trained in life-saving skills. A running water supply was established. Subsequent community interventions focused on improving access and reducing the delay in seeking care. Results: The number of women with complications coming for care increased almost three-fold, from 26 in 1993 to 73 in 1995 and the proportion of these who were referred for treatment dropped from 42 to 14%. Surgical obstetric procedures performed at JTHC increased from 23 in 1993 to 90 in 1995. Midwives performed 32% of manual removals, 58% of vacuum extractions and 98% of episiotomy repairs. No deaths occurred among the women treated. Costs: The cost of improvements was approximately US $30 000, mostly for equipment and supplies. Forty percent came from project funds, 36% from Ž . non-governmental organizations NGOs , 15% from government and 9% from community members. The salary of the new physician cost an additional $4700 annually. Conclusions: Modest improvements can increase the provision and utilization of emergency obstetric care. Collaboration with NGOs, government and the community can be beneficial.  1997 International Federation of Gynecology and Obstetrics Keywords: Africa; Ghana; Maternal mortality; Obstetric services; Utilization; Midwives  Corresponding author, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana. Tel.: 233 5122301; fax: 233 512308. 0020-729297$17.00  1997 International Federation of Gynecology and Obstetrics Ž . PII S0020-7292 97 00151-3