Ergler, C., Sakdapolrak, P., Bohle H.-G. & R. Kearns (2013): From effective cure to affective care: Access barriers and entitlements to health care among urban poor in Chennai, India. In: Luginaah, I. et al. (eds.). Geographies of Development and Health. Farnham: Ashgate, Geographies of Development and Health Series. (forthcoming) From effective cure to affective care: Access barriers and entitlements to health care among urban poor in Chennai, India Ergler, C., Sakdapolrak, P., Bohle H.-G. & R. Kearns In 2011 the world’s 7 th billionth person may have well been a girl, born in India, a country in which most people continue to live in poverty. Poor people in cities are the ones who suffer most from the numerous environmental, economic and social risks that shape health status in a rapidly urbanising environment (Akhtar 2002, Harpham & Molyneux 2001, Krafft et al. 2003). In this respect, this girl is very likely to grow up in poverty and fall ill in one of the major slums in an Indian megacity. She may encounter various infectious diseases associated with poverty (e.g. tuberculosis, cholera or typhoid), but she will also be prone to ‘lifestyle’ diseases such as diabetes (e.g. Nanda & Ali 2006, Patel et al. 2011). India, like many other developing countries, is at the brink of a health transition as the result of complex societal and economic changes. Their health care systems deal, or will have to deal, with this health transition in diverse ways. By way of example, they increasingly need to cater for the needs of people suffering from not only communicable but also non-communicable diseases, while the (financial) resources have not be adjusted to deal with this double burden (Patel 2007) . So what are the girl’s entitlements to health care? Along with many others from the growing Indian population, the girl and her parents may seek help for her illnesses – as they are entitled to – in the easily accessible public health care system, but it is also very likely that the family will decide on treatment by a private practitioner. In India private sector health care resources, which tend to be concentrated in urban areas, are commonly accessed by impoverished users (e.g. Akhtar 2004, De Costa et al. 2009, Peters et al. 2002). For example, a study from Delhi reveals that impoverished residents mainly attend private sector facilities involving out–of pocket payments despite the provision of care at subsidised government facilities which are meant for those with fewer resources (Gupta & Dasgupta 2003). Thus, even geographical availability and physical proximity of public facilities do not necessarily imply better access for poorer urban residents as other factors also play a role (i.e. Acharya & Cleland 2000, Andersen 1995, Butsch 2008, Dilip 2005, Obrist et al. 2007, Penchansky & Thomas 1981). In the case of the girl introduced earlier, it will be important for her present and future health–seeking behaviour where facilities are located and how she and her parents feel about, experience and remember these visits; it will also be important to consider how the health service, as a place for cure and care, is represented (Ergler et al. 2011). If the family follows the example made by numerous other Indians of a similar location and social class, their preference will lie in the private sector. In this chapter, we address the apparent paradox of poorer residents using fee-for-service health care by drawing on a case study from the megacity city of Chennai in the South of India. We