Community Involvement is a primary concern in Nepal as in other developing countries' health systems. This district case study analyses the interactions between the community and the health service providers, appraises the qualitative performance of district health services, describes the community felt needs as opposed to the professionally defined needs and assesses the degree of community participation in health achieved. Experimental use of a combination of methodological approaches to operational research is made, which seems to be promising for health systems evaluation as well as for further research into the borderland of socio-medical, anthropological and public health issues.