Summary Health service delivery remains a challenge for rural Kenya. Health sector reforms have come in at a time when different models are being tried to improve access and utilisation of health services being offered by various providers, such as NGOs, government and private for?profit practitioners. This article will examine a model that World Neighbours has been trying out. It explores questions raised by this model such as: can community voices influence quality and type of service? Can communities access and use services being offered from a facility where they do not decide on management, staffing or supplies? Can the more vulnerable members access these services where they have to pay? What institutional arrangements spur the energy of a community to influence health service delivery? The article analyses the above questions in light of trends of health service delivery from 1990s to date in terms of policy environment versus reality on the ground, using the example of Mukuyuni Health Centre where World Neighbours has been operating.