This report describes a community participatory approach for improving health in urban slum communities in Nigeria. The study site included 6 slum communities in Lagos State. Public health conditions included poor hygiene, overcrowding, blocked drainage systems, lack of toilet facilities, feces-contaminated water, and cramped housing construction. Drinking water was unavailable, and people obtained paid water per bucket. These communities had taken it upon themselves to improve conditions. People built roads, acquired electricity, dug gutters, and planned their communities. In one community, a school was built; in another, a health center. One community spent its energies preventing another relocation. Interviews revealed people's interest in talking about the history of their communities, the peculiar problems faced, their organizational structure, and solutions to improving their lives. Slum dwellers did not view themselves as poor. People wanted drinking water, better roads linking their community to the larger community, expanded canals to prevent flooding, good drainage, electricity and street lights, good education, literacy education, modern equipment for sand dredging, improved fishing systems, better buildings, a policy department, libraries, and recreational facilities. No one mentioned health education. Without this assessment, the author would have set up an inappropriate health education plan. The alternative was to help these communities secure funding for their desired projects.