This paper reports on the findings of participatory research undertaken in three settlements within Dakar which sought to develop concrete actions for achieving “healthy towns and villages” and which also identified the constraints on such action. It begins by describing the key healthy city principles – local authority involvement, dialogue and coordination between sectors, and community participation. It then outlines the range of participatory techniques used in diagnosing problems and developing proposals, and discusses the potentials and constraints on their successful implementation. This highlights the potential contradictions between the “healthy cities” philosophy and conventional local authority management culture. But it also points to the more favourable conditions provided by decentralization and by new models of urban management which rely on the increased use of partnerships between neighbourhood associations, NGOs and local authorities.