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When it comes to creating community-directed health programs, it’s often the community voices that are the last to be heard, though they are the first to be affected. Decades of well-intentioned programs—designed for communities rather than with them—have produced interventions that underperform, erode trust, and fail to sustain. The evidence is clear: when people most impacted by inequities are genuine co-designers of solutions—not just recipients of services—outcomes improve, trust deepens, and change lasts. This session brings together practitioners who have built programs that model a different approach, centering community knowledge, lived experience, and self-determination as core design inputs, not afterthoughts.