This paper describes the development of a “healthy municipality” initiative in León, Nicaragua’s second largest city, in 1995, and of the innovations in local governance that preceded it - especially the partnerships that local government developed with the university, bilateral agencies and the long-established urban social movement. The healthy municipality initiative helped bind and mobilize support for the already established partnerships set up to address poverty and health and environmental problems. The emphasis has been on building the capacity of urban social movements to interact with local government in the process of policy-making. After first discussing why participation and good governance are so central to “healthy cities”, the paper describes the specific conditions which fostered the participatory approach in León, and the difficulties faced - especially
an unresponsive central government. The paper also analyzes the process of citizen participation in policy-making and the contents and results of the programme. León and its surrounds were also severely affected by the recent hurricane Mitch - and the paper describes how important the existing local capacity and the healthy municipality initiative proved in addressing the immediate needs of communities during and after the emergency.