The Global strategy for women’s, children’s and adolescents’ health (2016–2030) calls for action towards three objectives for health: survive (end preventable deaths), thrive (ensure health and well-being) and transform (expand enabling environments). 1 The strategy recognizes that “women, children and adolescents are potentially the most powerful agents for improving their own health and achieving prosperous and sustainable societies”. Global, national and sub-national development policies have until now been largely orientated towards addressing the objectives of helping people to survive and thrive. However, to accomplish the overall objectives of the strategy we need to address the third objective:“to transform societies so that women, children and adolescents everywhere can realize their rights to the highest attainable standards of health and well-being”. Transforming societies requires participation, including communities working together with health services to reach health goals (what is termed co-production). In this paper, we examine what this implies in practice. Community participation is promoted in global dialogue as a vital element of a human rights-based approach to health. This means not just ensuring the provision of health services and their use by the public but also tackling the underlying social determinants of health. 2 While proven clinical and health service interventions could save numerous lives by 2030, if they were made available to all, those people most in need of health care are often not reached. 3, 4 Many factors–wealth, environment, gender, education, geography, culture and other structural determinants–affect health outcomes directly through health services uptake, and indirectly via relationships and behaviours outside the clinic setting. 5, 6 Community participation that is inclusive of underserved groups and is tailored to context is a fundamental principle of equitable primary health care as well as a way of optimizing interventions to improve health.