This qualitative study sought to understand the instrumentalities, tactics, and persistence demonstrated by midwives and nurses delivering maternal and neonatal care in resource-poor rural health care facilities in six districts of the Northeast Region of Ghana. Interviews with 45 respondents (25 midwives and 20 nurses) show that in the absence of supplies like plastic sheets, boiled scissors and mobile phone flashlights, the delivery staff resort extensively to improvisation. The adaptations were clever but could compromise infection control and provider safety. The study established key coping strategies like switching among tasks, adapting protocols, peer support and spiritual survival as well as technical resources and study parrticipants were examples of creativity and emotional stamina. Despite infrastructural constraints, care continuity is preserved through shift rotation, home-visits and flexible appointments. Volunteer delivery, and integration with the local traditional birthing staff, were important to make services available. Frontline providers are remarkably resilient, the study concludes, but systemic change is vital. Suggestion: Give basic tools, essential supplies to health facilities, strengthen infection preventioninfrastructure and supplies, improve referrals and subsidies for health retention in rural locations to develop an effective and equitable rural health system.