The case study about the participation on the Rio de Janeiro Municipal health policies analyses both the process of institutionalization of the Conselho Municipal (CMS) and the Conselhos Distritais de Saúde (CODS) and their regulamentation by initiatives of the Câmara Municipal (CM), taking into consideration the constitutional principles of 1988 over the past 25 years, with emphasis on the period between 2009 and 2013. The concomitant consolidation of the Promotoria de Tutela Coletiva da Saúde da Capital do Rio de Janeiro is also analyzed, as well as its founding, growth and functioning, concentrating on the recent participative actions promoted by sectors of the Ministério Público of Rio de Janeiro. Based on comparative analyses, the research tried to point out the city s own perspective. Taking into consideration the national dynamic, the research contrasted the municipal logic with the district experience. The systematization of the legal framework of public health policies, meetings notes, participatory observation of meetings, public audiences, interviews and documents of the Hearing Sessions of Ministério Público were all used to construct the present analysis. Reactions of Rio de Janeiro s politics to the then possible municipalization prior to 2008, the health crisis in the city and the political forces that resisted were considered in a historical perspective. The crucial points of political dissent concentrated on the new model of OSes (Organizações Sociais) that were being implemented by the Prefeitura Municipal and the proposal of a new health office for the city called RioSaúde.