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MSF has been present in the Nchelenge region since 1998, when a program was started to provide health care to Angolan and Congolese refugees who had arrived in the region. The MSF project in Nchelenge District was started in April 2001 because of lack of access to HIV/AIDS care in an area with an HIV prevalence estimated at 16.5%. The objective was to achieve a high coverage of treatment and care, and at the same time provide a model for decentralised programs to bring HIV/AIDS treatment and care to all people in Zambia and for MSF Holland/OCA more widely.

Kamalini Lokuge, Robert Musopole and Mupundu Banda

Médecins Sans Frontières has been running HIV/AIDS treatment programmes since 2001. As national systems scaled up capacity, MSF began to hand over HIV projects in 2005. Variable experience with handover and internal debates about MSF responsibility to patients led OCG to propose an evaluation of the handover process, to learn from experience and inform policy and practice. A qualitative review was carried out through interviews, case studies in Cameroon and Laos, and review of other vertical and integrated HIV projects.

Dr. Rosamund Lewis and Dr. PehrOlov Pehrson

MSF is one of the pioneering organisations to implement HIV & AIDS related interventions including ART in different settings. Understandably, the organisation is thus often solicited to provide information on cost analysis of programs. This is the purpose of this study into 3 different MSF HIV/AIDS programs: Kenya, DRC and Malawi. The present study proposes a detailed description of the cost for the HIV/AIDS program in Thyolo in Malawi for the period of time from 2005 to 2007. The methodology used is inspired by the “Activity based costing” (ABC approach)

Guillaume Jouquet

The purpose of this document is to provide an overview of the handover of the HIV program to the Bureau of Health (BoH) in the Kahsay Abera Hospital (KAH), Humera, Ethiopia, in 2007. The lessons learnt during the handover process could be of value to other MSF teams faced with an impeding handover of activities to the local health structure. A document in this vein was written directly following the handover in July 2007 however this current text acts as an updated version using the knowledge gained during the ten months following handover.


The formation of HAACO was initiated by Medecins Sans Frontieres (MSF) who had been operating a HIV/AIDS project since 1999 in Khayalitsha in the Western Cape and since 2003 in rural Lusikisiki in the Eastern Cape province. Most of the services provided by the MSF project were handed over to the DoH. However the adherence element was not. The DoH had neither the financial nor the structural capacity to take on the Adherence programme. Hence the formation of HAACO. This process was intended to review the strategic options for the future of HAACO.

Sunjay Panday and Loretta van Schalkwyk

MSF's HIV/AIDS project in Thyolo district, Malawi was one of the MSF movement's earliest efforts to address HIV/AIDS in sub-Saharan Africa, beginning in 1997. The handover of project responsibilities from MSF Luxembourg to MSF Belgium took place in 2005. MSF Belgium agreed to undertake this external evaluation of the project with the goal of assessing the project's performance, identifying constraints preventing the achievement of its goals, and proposing recommendations to improve overall effectiveness.

David Evans

Following the handover of AIDS treatment programs to the authorities of Guatemala, MSF conducted a study to assess various aspects of the continuity of HIV/AIDS care. This review was conducted 18 months after MSF left the Roosevelt hospital, and examined both the clinical data and opinions of staff and patients. Despite some shortfalls in the frequency of laboratory testing and community follow up, the level of care and outcomes for the patients was well maintained by the hospital staff.


MSF closed all operations in Lusikisiki at the end of October 2006. That date marked the end of four years of operations setting up a model of comprehensive and decentralized HIV care in one of the poorest and most underserved rural areas in South Africa with a high prevalence of infection. The model implemented has been widely used in South Africa to influence relevant policies. This report looks at the chain of events following the handover and changes in the model of care.


This evaluation is best understood as a peer review aimed at learning from the experiences of 3 different sections of MSF operating HIV/AIDS programmes in Malawi. Our aim was to evaluate how specific differences in objectives might impact on programme strategies and whether these differences would be relevant when assessing programme outcomes. The general issues of interest were decentralisation, simplification and task shifting in relation to the expansion of ART services.

Richard Bedell, Jean-Marc Biquet, Alexandra Calmy

MSF had been working in Honduras and Guatemala in HIV prevention and care of people living with HIV and AIDS for several years before ART projects were started in 2001. In 2005 the projects were handed over to the National AIDS Programme, though MSF-CH kept some staff in both countries to monitor progress. This evaluation was planned a year and a half after handing over the project, to document the perception of people regarding lessons learnt; whether the project was handed over properly; and the quality of care for people living HIV.