Two programs using locally trained paramedical personnel provide health care to villagers in Bangladesh. The general level of care rendered appears to be above average for the country, but varies with the individual paramedical worker. Field supervision is crucial to quality of care. The structure of the two programs places physicians in direct contact with the paramedical workers for supervision and consultation. Unlike most programs in less developed countries, these emphasize preventive care, prepaid insurance at minimal premiums (in one plan, premiums are payable by barter), and apparently high motivation of the staff, many showing personal concern as well as evidence of sound training.