Purpose – This paper sets out to contrast the ubiquitous, globalizing influence of new public management (NPM) with an alternative approach more attuned to the local needs of communities, especially those with health and economic problems in less-developed countries. The Ugandan Community-led HIV/AIDS Initiative is drawn on to contrast the operation of “bottom-up” accountability – whereby the deliverers of public services are accountable primarily to the communities they serve – with the usual expectations of an NPM model, which instead focuses on holding public sector managers accountable to their political masters. Design/methodology/approach – A hermeneutics approach is adopted to interpret evidence from: government policy documents; interactions and interviews with public sector actors at national, district and community levels; and one author's own pre-understanding from his role with the Uganda AIDS Commission. Findings – This Ugandan illustration suggests potential benefits from importing workable aspects of NPM reforms while at the same time exploring other service delivery and accountability options that fit the needs of target communities in less-developed countries. Research limitations/implications – Uganda's adoption of the outlined community-led approach has important implications for the (ir)relevance debate around NPM reforms in developing countries. However, as this paper is based on a single initiative in one country, it represents only a first step towards understanding the potential for innovative public sector models to add value in developing countries. Practical implications – The findings point to community-led approaches, such as those adopted in Uganda, as a promising alternative to NPM models for improving public service delivery and financial accountability in less-developed countries. Originality/value – Communitarian and social capital theoretical perspectives are drawn on to analyse novel public sector management and accountability mechanisms and compare the findings with dominant NPM perspectives. The research context contributes new understanding of how NPM reforms might be adapted and supplemented to benefit developing nations.