This project on health related telecommunications (telehealth) in Western Australia aimed to address the lack of a suitable, economically costed communications infrastructure to support telehealth in rural and remote areas. The project used participatory action research techniques and involved extensive community consultation. This paper discusses local participation in projects that are centrally initiated and controlled. Barriers to the planning process identified by study participants were: lack of local community inclusion in planning committees; poor communication within central government; overuse of external consultants; local information being overlooked in the final implementation plan; a bias toward the medical view of health services; and a limited scope of invitation to contribute.