This paper presents findings from acommunity-based study testing the effectiveness ofparticipatory approaches in improving services and outcomesfor youth reproductive health in Nepal. The study wasmotivated by the desire to test the impact of participatoryapproaches in improving youth reproductive health. Nepal waschosen because it is a country where youth reproductivehealth needs are especially acute and little is being doneto meet them. In this study, the authors test whether manyof the key principles advocated by development practitionersfor making services work for poor people can be effectivelyoperationalized through small, community-based programmaticinterventions. In particular, the study seeks to establishwhether participatory intervention programs can increaseempowerment of poor and disadvantaged populations andaccountability to them.