The first two sections illustrate the nature of the urban governance of primary and public health services, including water, sanitation, waste disposal and food safety, through a review of existing policy and relevant legislation and the institutional arrangements for their implementation. The next two sections focus on the nature of policy implementation in practice by illustrating the nature of urban poverty in Bangladesh and the extent of access the urban poor have to primary and public health services. Based on these illustrations, the penultimate section pinpoints the policy and institutional weaknesses contributing to the limited access of the urban poor to the existing services. The final section of the paper concludes the study and puts forward certain recommendations for improving the situation which have implications for the Asian region at large.