The objective of this evaluation was to compare the substitutional approach in Gety project to the approach focused on capacity building and skills transfer in Boga. The evaluation found that in both Boga and Gety, MSF succeeded to considerably improve the quality of care during its presence. Access to health care in Gety was arguably better according to the perception of the population. In Boga, access to primary health care remained limited up until the start of the community-based health care programme launched towards the end of the project. However, limited access to the HGR (Hôpital Général de Référence) was noted in Gety, whereas the number of visits to the HGR in Boga radically increased during MSF’s presence. Hospital management remained a challenge in both projects despite the administrative support available in Boga project. The arrival of MSF to Gety led to setting up a parallel health care system, which initially was not welcomed by BCZ (Bureau Central de la Zone de Santé). However, as the project progressed, the partnership was respected, and collaboration improved. Evaluators argue that both projects could have benefited from a more active relationship with the Ministry of Health from the start of the projects. Especially for a project like Boga, it is necessary to accept that objectives are consistent with the country's health policy and standard, the HR ratios, the national treatment protocols and the drug availability. Evaluators highlighted the lack of clarity on MSF institutional will to assume the projects like Boga and contradicting messages coming from different HQ departments (expected quality of the services not adapted to the support character of the project). This dichotomy contributed to the premature closure of Boga project.