In Bangladesh, the health risks of unplanned urbanisation are disproportionately shouldered by the urban poor. Key findings of the paper include: unlike rural areas, organised systems of primary care provision are lacking in urban Bangladesh, and apart from limited services through non-government organisation, is altogether absent in urban slums; informal private-for-profit providers have strategically filled this gap and cannot be ignored in efforts to increase effective coverage of services particularly for the urban poor; and formal service delivery efforts can learn from the successful strategies employed by this sector, and at the same time, harm can be minimised through intelligently crafted incentives that encourage the application of quality standards.