Background: Preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women’s lives every year, almost all in low- and middle-income countries (LMICs). However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity.

Objectives: To assess the contribution of task-shifting of emergency CS in south Ethiopia and forward recommendations for evidence-informed decision making.

Methods: Between 2009 and 2013 a task-shifting intervention to train CS teams involving health officers, general practitioners and anaesthetic and scrub nurses was implemented in 13 hospitals in Southern Nations Nationalities and Peoples Region of Ethiopia. A cross-sectional study involving review of secondary data and interview with focal persons of comprehensive emergency obstetrics and newborn care was conducted to appreciate the contribution of task shifting of CS in primary hospitals in southern Ethiopia. Data from delivery and CS registers of the hospitals (for the six months before and after task shifting commenced) were collected.

Results: Comparing the hospitals’ performance before and after the task-shifting process was implemented demonstrated a significant increase in the number of CSs performed (Mean difference = 43.8; 95%CI: 18.3, 69.4; p=0.003) and the number of deliveries attended (Mean difference = 155.9; 95%CI: 48.9, 263.7; p=0.02) in the hospitals. However, non-retention of trained staff and limited continuous availability of blood transfusion cast a shadow on the contribution of task shifting. Other studies conducted in LMICs also revealed significant contribution of task shifting in improving access to CS services.

Conclusions: sound planning and implementation of task shifting of CS should be carried out in order to maximise the benefits from the innovation.