If primary medical care is to be provided to remote rural populations in developing countries, alternative and innovative delivery systems emphasizing community participation, use of paraprofessionals, and health education programs must be considered. A recent American Public Health Association study of 180 health projects in developing countries reveals that 92% of the projects are offering some sort of health education service, indicating the serious emphasis placed on the health education component. Methods being utilized to make health education a more effective part of the primary health system include radio campaigns in Tanzania and Assam, India, effective because the use of radio can overcome geographic and literacy barriers, and audio cassette programs for both group and individual listening in Guatemala and India. A Columbian program uses cassette communication for paraprofessional continuous training and provides a simple, low cost, portable, durable, flexible, and accurate means of health education. A Guatemalan project uses cassette and record/playback systems to assist student doctors in expanding the quality and quantity of their contacts with rural people. The health education programs outlined have substantial potential but unless there is strong political commitment to the systematic use of communication and administrative record keeping, it will be difficult to implement and assess innovative health education strategies. (NEC)