he Millennium Development Goals expire in 2015, and extensive efforts to ensure access to quality emergency obstetric care are required on a global scale. Maternal mortality is still a major problem worldwide. In 2013 alone, an estimated 289 000 women died due to causes related to pregnancy and childbirth [1]. The large majority of these deaths are preventable, as reflected by massive inequities in maternal mortality ratios (MMR), which amount to 100-fold higher in less privileged compared to affluent countries. Access to skilled care before, during and after childbirth has been defined as a prerequisite to save women's lives [2, 3]. Only 15 countries have an MMR of less than 5/100 000 live births, while figures at the other end of the scale for 16 countries are above 500, Sierra Leone being one of them. The challenge for Sierra Leone is a serious shortage of skilled health workers in combination with massive health needs, such as an unacceptably high maternal disease burden. This serious lack of human resources, along with massive health needs and weak capacities in training institutions, led to the establishment of a surgical training program in 2011. The aim is to provide physicians as well as community health officers with knowledge and skills for handling the most common life-threatening obstetrical and surgical conditions. Current evidence suggests that surgical task shifting is cost-effective and safe for selected procedures, and is recommended to improve access to key maternal interventions.

The present Ebola epidemic has overwhelmed an already very fragile health system, and women's health issues are at risk of being left even further behind. In this guest editorial we discuss the present experience and evidence for surgical task shifting in low resource settings.