This capitalization analyzes the experience of the Observatoire Citoyen sur l’Accès aux Services de Santé (OCASS) promoted by RAME in Burkina Faso, Niger and Guinea. The aim was to assess the role of Community-Led Monitoring systems on the availability, accessibility, acceptability and quality of services for HIV, tuberculosis, malaria and maternal and child health. The qualitative study involved a literature review and fifty-two semi-structured interviews with facilitators, providers, decision-makers, beneficiaries and partners. The OCASS system relies on associative focal points, collecting agents and digital data collection via KoboToolbox, supported by quarterly supervision and feedback. The results show a significant contribution to resolving input shortages, reducing absenteeism, improving the effective free provision of certain types of care and renovating infrastructure. Awareness-raising activities have increased knowledge of users’ rights and reduced discriminatory practices and violence in the healthcare environment. Improvements in reception, waiting times and the cleanliness of facilities have been reported. However, sustainability remains threatened by insufficient funding, limited logistical resources, governance challenges and problems of local acceptance, particularly in Guinea. The authors recommend diversifying funding, strengthening the integration of CLMs into health systems, equipping teams and systematizing the documentation of achievements to support the expansion and sustainability of interventions. Regular evaluative monitoring and strengthened local partnerships would facilitate rapid and sustainable scaling-up.