Summary Based on many years of experience in the monitoring and evaluation of health and related projects in Nigeria, this article emphasises the need for a new approach, giving much greater responsibility to community‐based organisations and allowing them a major role in consequent modifications to project design. It is suggested that this could greatly assist in fostering project ownership and hence the potential for sustainability. Emphasising the accountability of the project to the intended beneficiaries in this manner would also encourage those beneficiaries collectively to ensure financial accountability with regard to the use of donor and local project funds. Provision of training and support to enable community‐based organisations to undertake these new responsibilities could also have substantial multiplier effects on the local economy, as new skills, for example management of microcredit schemes for health costs, were applied in other sectors.