The study is to be conducted in Burkina Faso, Ghana, and Tanzania, three countries with a high lifetime risk of maternal and child mortality. An intervention and a control district were selected in each country.
The choice of the districts was based on; (1) districts that were typical for the country, and (2) districts that were comparable in terms of medical infrastructure, equipment and staffing, corresponding to national norms.
A decisive factor in selecting these study centers was the availability of electricity and cell phone networks. Additional factors were the availability of emergency obstetric care services to ensure the possibility to perform caesarean section and blood transfusion at the hospital level, and the presence of intravenous oxytocin and assisted vaginal delivery (episiotomy, in some health centres vacuum extraction) at the health centre level.
In Burkina, the intervention district is Nouna and the control district Solenzo, in Ghana the intervention district is Kassuna and the control district Builsa. In Tanzania Mtwara will be the intervention district and Lindi the control district.
Nouna has approximately 300.000 inhabitants, Kassuna 143.000, and Mtwara 205.000. All intervention districts organize primary health facilities with maternity units (27 in Nouna, 7 in Kassuna, 37 in Mtwara) that perform a significant number of deliveries. In 2006, about 2900 deliveries took place in Nouna, 1800 in Kassuna and 3000 in Mtwara.
All district hospitals are equipped with computers and have a regular power supply, which is backed up by emergency generators. In Burkina one third of all first line health facilities have solar cells. In Ghana there is uninterrupted supply, whereas in Tanzania local adapted solutions will be found.