The whole process of transferring decision-making from top- down to bottom-up demands a great deal of efforts and time for all concerned including the community members themselves. The frustration of leaders and citizens can run so deeply that the process can fail.. The ideal is to count on the top-down support policies from high levels of government However, there is enough evidence that bottom-up movements can influence positively the development and improvement of health in communities. One example of a positive influence is the experience of Zamora, Venezuela, a small town in which a community movement pressured local, state and national authorities to stop environmental contamination by a cement factory (OPS, Ministerio de Sanidad y Asistencia Social de Venezuela,1999). Negative experiences are difficult to find in the literature, but not always bottom-up efforts end in successes, and frustration of professionals and leaders is common in HP practice.