OBJECTIVES: The United Nations 2015 Millennium Development Goals targeted 75% reduction in maternal mortality. However in spite of this goal, the number of deaths per 100 000 live births remains unacceptably high across Sub-Saharan Africa. As many of these deaths could be averted with safe access to surgery including cesarean sections, the objective of this study was to assess the capacity to provide safe anaesthetic care for mothers in the main referral hospitals in East Africa. METHODS: The cross-sectional survey was conducted at the main referral hospitals in East Africa – Mulago, Uganda; Kenyatta, Kenya; Muhimbili, Tanzania; Center Hospitalier Universite de Kigali (CHUK), Rwanda; and CHUK, Burundi. Using a questionnaire based on the World Federation of the Societies of Anaesthesiologists (WFSA) guidelines for safe anaesthesia, we assessed demographic, administrative, peri-operative variables by interviewing anaesthetists in these hospitals, key informants from the Ministry of Health and National Anaesthesia Society of each country. RESULTS: Using the WFSA checklist as a guide, only four percent of respondents were able to provide safe obstetric anaesthesia, and only seven percent reported adequate anaesthesia staffing. There were only 30 anaesthesiologists in Uganda, 168 in Kenya, 22 in Tanzania, 15 in Rwanda, and 2 in Burundi. Hospitals were barely equipped with monitors that sometimes were not functional. The paucity of local protocols, the failed referral system and lack of intensive care unit services was also reported to contribute significantly to poor maternal outcomes. CONCLUSIONS: We identified significant shortages of both personnel and equipment needed to provide safe anaesthetic care for obstetric surgical cases across East Africa. There is need to develop policies and strengthen the health systems in order to improve surgical outcomes in developing countries.