Scope and Limitations of Municipal Health Councils: A Case Study Carla A. A. Ventura, Mauro Serapioni, Marcela J. Miwa , and M arjore S. Jorge This case study analyzed citizen participation at the Municipal Health Council (MHC) of Ribeir~ ao Preto, in the state of S~ ao Paulo (Brazil), using a qualitative approach with a phenomenological basis and methodological triangulation: (i) analysis of the minutes of the meetings, (ii) passive observation, and (iii) semi-structured interviews with councillors. The interviews were analyzed using content analysis and categorized according to three themes: (i) challenges and limitations of participation in the MHC, (ii) representativeness of the councillors, (iii) the Council and its influence on local health-care policies. Problems with infrastructure and the organizational logistics of the MHC, as well as relational difficulties among members occupying varied roles and having different levels of knowledge about health, influenced the quality of the deliberative process. In contrast to studies that indicate poor participation by health-care service users in spaces of dialogue around health-care policies, this study found the users actively engaged and committed. KEY WORDS: citizen participation, health councils, Brazil Introduction Internationally, citizen participation has been increasingly on the agenda in discussions on the process of health-care reforms. In recent years, the demand for greater participation of civil society has increased, and political and social scientists have taken a growing interest in analyzing the social practice of participation that leads to active citizenship and high-intensity democracy (Santos, 2002). Arguments in favor of citizen participation in health-care decision-making processes include: (i) the experiential knowledge of health-care service users improves the quality of decisions (Barnes et al., 2008; Rojatz & Forster, 2017); (ii) public health care is most effective when decisions are shared with those affected (Scutchfield, Hall & Ireson, 2006); (iii) community health needs must be aligned with health-care services (Abelson et al., 2003); (iv) the users’ perspectives should be valued in the decision-making process (Charles & De Maio, 1993); (v) the World Medical & Health Policy, Vol. 10, No. 1, 2018 65 doi: 10.1002/wmh3.259 # 2018 Policy Studies Organization