AbstractPopular participation has been an important component of most primary health care strategies since the Alma Ata Declaration, 1978. This article examines the use of state‐sponsored participation in the health sector in Peru and some of the experiences that have accompanied its implementation. Taking the Local Health Administration Committees (CLAS) from the second Fujimori government (1995–2000) as an example, it is shown that for self‐motivated rural communities to work in harmony with the state, there must be willingness to adapt to the varying levels of intra‐community differences, social integration and social support. Copyright © 2004 John Wiley & Sons, Ltd.