One of the major problems in Africa is that services provided by government often do not reach communities, especially rural communities (eg see Khanya, 2001). One way of addressing this is via community-based workers (CBWs) such as community animal health workers, homebased carers, peer educators etc. Lessons from Uganda, South Africa, Lesotho and Kenya suggest that these models can be applied at large scale and can have a major impact on livelihoods. These lessons are drawn from several sectors including natural resources. To scale up such approaches successfully requires rethinking service provision, and a major investment in the capacity of civil society. Methodologies for scaling up need to be developed including  tandardisation of training and allowances, large-scale capacity- uilding of civil society to take forward such approaches, as well as coordination and management of potentially numerous CBWs in communities. Government will need to mainstream funding such approaches, seeing them as front-line service delivery and so a priority rather than the last to be funded. Resistance from some professionals needs to be addressed for this to succeed, with clarity that improved front line delivery will result in increased demand for value-added professional services.