A nurse-assisted, community-led health initiative, part of a Canadian-Irish project called ‘Transformative Praxis: Malawi’, has been developed with the aim of empowering community volunteers to become leaders in their community’s health. This paper traces the growth of this initiative over the past 3 years and explains some of the challenges that have been experienced. It explores how a grass-roots approach, linked to a community hospital, and working in close collaboration with other healthcare providers in the region, provide a platform for future health developments.