Asian Journal of Pregnancy and Childbirth

This systematic review synthesised evidence since 2017 on birth preparedness and complication readiness in Ghanaian hospitals, with emphasis on organisational strategies that shape counselling, planning, referral and blood readiness. Searches of major databases and Ghana repositories were followed by dual screening, structured extraction and quality appraisal using the Mixed Methods Appraisal Tool. Facility-linked data from Accra showed high overall preparedness at 78%, with strong facility delivery and insurance coverage, but weaker donor identification at about 50% and incomplete danger sign literacy at about 58%. In three disadvantaged rural districts, poor preparedness affected about 23% of women and referral plans were uncommon at 12.8% with wide district variation in transport and donor arrangements. In northern Ghana, fewer than 15% met an adequacy threshold and preparedness correlated with education, danger sign knowledge, and adequate antenatal contacts. Taken together, the evidence indicates that contact with facilities alone did not secure complete planning without structured counselling, item-level tracking, functional referral protocols, and active liaison with blood services. Priority actions are a standard preparedness checklist and monthly dashboard, expansion of group antenatal sessions and maternal clubs, written day and night transport and referral plans by 32 to 36 weeks, and antenatal donor identification integrated with social protection. These actions are feasible within existing hospital workflows and align with Ghana’s quality improvement platform.