Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and the Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006. It included an investigation of trends in rates of major obstetric interventions and newborn and mothers’ outcomes, interviews with key informants, workshops with the community and focus group discussion with final year medical students regarding the implementation of the policy. Since 2000 eleven surgical teams have been trained but only six were still functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team was put in place. However the rate was never sufficient to meet the need for obstetric surgery. Central decision-makers consider the policy more viable than training gynaecologists for district hospitals. However, obstacles included resistance from academics, a perceived lack of career progression for the doctors trained, and lack of programme coordination. Practitioners felt that the work was valuable, but they raised problems of low additional pay and not being replaced during training. Communities appreciated that the services saved money and lives, but called for improved information and greater continuity of care.