A project brought together international footwear manufacturers, labor rights groups, local contract factories, and occupational health professionals to strengthen factory health and safety programs in southern China. Steps involved in the two-year project, including needs assessment, interviews and focus groups with workers and supervisors; design and development of a participatory workshop; development of plant-wide health and safety committees in three footwear factories; and evaluation project impact, are discussed. The project significantly increased occupational safety and health knowledge, and hazards in the factories were identified and corrected. Successes and challenges faced by three functioning worker-management health and safety committees are discussed. Key elements to create effective programs with meaningful participation by workers include: 1) developing clear guidelines that enable multi-stakeholder groups to collaborate; 2) obtaining top-level management support; 3) building workers' knowledge and capacity to fully participate; 4) involving local labor rights groups and occupational professionals in support and technical assistance; and 5) connecting project goals to larger issues within a country and the global economy.