Based on many years of experience in the monitoring and evaluation of healt
h and related projects in Nigeria, this article emphasises the need for a n
ew approach, giving much greater responsibility to community-based organisa
tions and allowing them a major role in consequent modifications to project
design. It is suggested that this could greatly assist in fostering projec
t ownership and hence the potential for sustainability. Emphasising the acc
ountability of the project to the intended beneficiaries in this manner wou
ld also encourage those beneficiaries collectively to ensure financial acco
untability with regard to the use of donor and local project funds. Provisi
on of training and support to enable community-based organisations to under
take these new responsibilities could also have substantial multiplier effe
cts on the local economy, as new skills, for example management of microcre
dit schemes for health costs, were applied in other sectors.