Brazilʼs left, especially the Workersʼ Party (PT), largely views civil society participation as a means of correcting the shortcomings of liberal democracy, and to break clientelistic politics. This article questions the underlying assumptions that civil society is inherently a pro-democratic force and that participatory arrangements enjoy sufficient autonomy from local power dynamics to democratise state action. Effective participation requires a positive interplay between government commitment, civic virtues, and supportive institutional design. Participatory democracy presupposes a well-functioning representative democracy rather than curing its ills. The article compares four municipal health councils in towns with varying combinations of government commitment and civicness, which highlights a complex interaction of political, civic, and institutional factors that shaped deliberative participation.