Vanuatu is a classic example of the three delays in surgical services. Paediatric patients face even greater challenges due to delays in seeking health care, delays in transportation and delays in being seen by a surgeon with paediatric experience. Surgical work force development and training has produced a strong cadre of surgeons who are mainly located in Port Vila. Surgical outreaches and the support of visiting medical teams will continue to provide patients with the essential and timely care that is needed. A strong national focus on service delivery and safe access to surgery is pararmount including training for nurses, doctors and engaging in local and regional partnerships to strenghten paediatric services in Vanuatu.