In the past, interventions focussed on a top - town approach. Such interventions have not been successful. The current focus is based on facilitating social capital through small group formation and well directed, non- intrusive economic interventions. This paper examines the changing concepts of institutional development interventions and their positive and negative impacts, with examples from the Hindu Kush- Himalayan (HKH) region. In the end, the author poses some research questions and partinent issues as part of the framework of an institutional governance, and social capital approach to poverty reduction and sustainable development in the HKH.