Kanyeleng fertility society musicians have become an integral part of health promotion programs in the Gambia. Health workers have embraced kanyeleng performance in the name of making their programs more participa- tory and therefore more effective in combatting persistent health problems. While participation has become a buzzword in global health discourse, the contested social relations of musical performances have not been adequately examined. Bringing a medical ethnomusicological perspective to interdisci- plinary debates on participation, this article foregrounds the participatory dynamics of music making as they intersect with local concepts of music, health, and well-being.