Ghana has a maternal mortality ratio of 380/100,000 live births and a neonatal mortality rate of 28/1,000 live births. Although most of these deaths could be prevented by timely access to quality care during medical emergencies, the country lacks a functional emergency referral care system. To test feasible means of addressing this need, the Sustainable Emergency Referral Care (SERC) Initiative was piloted in the Upper East Region of Ghana. Objectives: This study was conducted to understand the

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... role of and need for knowledge about emergencies on the utilization of emergency referral services in study setting. It describes community members' ability to recognize and respond to signs of obstetric and neonatal emergencies with the goal of eliciting potential strategies for an effective community education component of the SERC program. Methods: Seven focus group discussions were conducted among homogenous groups of community members in three districts. All discussions were audiotaped and transcribed verbatim, coded in NVivo 10.2 software and analyzed using framework analysis. Results: Most respondents recognized emergencies as life threatening conditions that require urgent intervention but there were varying views about emergency types and the appropriate responses for each type. Some emergencies were considered to be "frafra issues", which meant traditional issues peculiar to a specific tribe. Such misconceptions, certain cultural practices and social dynamics that influence the decision to seek and utilize referral services were elicited. Conclusion: There were clearly mistaken beliefs and detrimental practices that merit specific focus in an educational program. For instance: the perceptions of certain emergencies as traditional or spiritual problems and consequently seeking spiritual, rather than medical, treatments for those, needed to be addressed. Dialogue generated practical recommendations for developing the content of educational materials and improving the appropriate utilization of emergency services.