This article provides lessons learned on establishing effective community participation in two externally funded, NGO-implemented health projects working at district level in Cambodia. The first project was implemented in accordance with the Cambodian national guidelines on community participation. The second – using lessons and experiences gained as a result of the first project – worked with Buddhist pagoda volunteers. Primary research was conducted in both settings to assess the effectiveness of the two participation strategies. The article concludes that the success of community participation in externally funded health projects with relatively short implementation timeframes requires engagement with existing community-based organizations and agencies. In Cambodia, where Theravada Buddhism is the dominant religion, pagodas and associated volunteers appear to represent such an organization. Community participation structured around pagoda volunteers – who are held in high esteem within their local communities – is more effective and sustainable than newly (and externally) established community structures with formally elected representatives. Pagodas and associated volunteers in rural Cambodia offer the advantages of effective leadership, local organization, resource mobilization and management. It is recommended that programmes and agencies wishing to adopt community participation strategies in health utilize participatory research to identify the most appropriate local organization to lead such initiatives.