The aim of this empirical study is to refl ect on urban governance in India’s large metropolitan cities by examining healthcare services in Delhi, Hyderabad and Mumbai. The objective is not a strict comparison of the cities per se, indeed the data sets available are not identical for the three cities, rather the idea is to use a comparative perspective to tease out general fi ndings about the evolution of supply and demand for a given service in relation to a particular governance situation. These three cities are situated in different regions of the country, characterised by distinct political cultures and they occupy dissimilar positions in the urban hierarchy. It will be seen that this heritage contributes in a signifi cant way to explaining the variance we observe with regard to governance between the three cities. Notwithstanding, they are exposed to a common overall policy framework and similar forces are clearly at work in each, reshaping service delivery and redefi ning the respective roles of different categories of actors. As outlined in Chapter 1, the main analytical focus is on changes that have occurred over the last 10-15 years as a result of decentralisation and economic reform.