Worldwide contemporary health care systems are affected by political, organizational and financial reforms. They have three major impacts : an increase of competition between health care structures, the development of new partnerships between actors and the increase of interactions between levels. Based on the analysis of the Indian Public health care system, this paper points out the difficulties for understanding the contemporary Indian health care landscape. Focusing on the “instruments of public action” (Lascoumes, Le Galès, 2005) and their spatial arrangements may help to give a better picture of the contemporary changes. This point is highlighted by analysing the role of Non Governmental Organizations (NGOs) in the transformations in the health care system. In this paper, a methodology is proposed and applied to the study of four NGOs.