The scope of this study was to analyze the decentralization of health management at city level and its implications for comprehensive access and care for users. A "scoping review" located 1,902 references. After being subjected to the criteria of inclusion and exclusion by judges, 27 articles were selected and charted. The research revealed the following issues: what it was possible to establish by the process; problematic points in charting the path and prospects of decentralization. The following aspects were identified: increased access to primary care through increasing the number of professionals and family health teams; planning, evaluation and inter-sector aspects were seen as problematic; planning and management instruments are limited, and cities face difficulties in relation to medium and high complexity care. Funding is still a barrier to the advancement of decentralization, few studies have analyzed the guarantee of access to medium and high complexity care and studies that define the reality of small cities are needed. Several challenges were identified, such as the need for implementation of the regionalization process, shared management and an inter-federative network that ensures comprehensive access to health care.