Project Fives Alive! aims through the application of quality improvement (QI) methods to assist and accelerate Ghana’s efforts to achieve the Fourth Millennium Development Goal of reducing under— 5 mortality by 67% from its 1990 baseline of 110-120 deaths per 1000 live births to less than 40 deaths per 1000 live births by 2015. Operational since July 2008, PFA! has worked with frontline health workers to develop, test and implement successful change ideas that have proved useful in overcoming system barriers accounting for preventable deaths in children less than five in Ghana. Starting from three districts in the Northern sector of Ghana, the project is now scaled up in all 38 districts in Upper East, Upper West and Northern regions of Ghana and in 32 hospitals of the National Catholic Health Service scattered all across the country in various districts. Effectively tested and implemented ideas within districts, sub-districts and the hospitals to improve processes in the continuum of care have been documented into two “Change packages” - one for successful changes in antenatal, skilled delivery and post-natal care and the other in hospital-based care.