Among the Kassena-Nankana of northern Ghana, compound heads and husbands impede women's prompt access to modern health care. This paper shows that such gate-keeping systems have a negative effect on child survival. To investigate the social construction of compound-based gate-keeping systems, the authors relied on a series of qualitative interviews conducted in the Kassena-Nankana district These data reveal that whilst compound heads are gate-keepers for spiritual reasons, husbands play such role for economic reasons. But more important, this article presents health interventions that are on trial in Navrongo (northen Ghana) and how they undermine such gate-keeping systems.