Doctors for the poor in urban Nepal.

Altruism on the part of doctors and other health workers may help make health services affordable for the poor, but the altruistic contribution of doctors who are nationals of developing countries has largely been ignored. This paper describes the results of two related surveys carried out between February and April 2001 to determine the characteristics of indigenous charitable clinics in Patan, Nepal, and the attitudes of the Nepali health professionals who work in them. In 2001, 33 Nepali health professionals were working without payment in 13 charitable clinics in Patan. Altogether they provided care to the same number of city residents as the general out-patient clinics of the city's 330-bed hospital. The scale of this activity had not previously been recognized. Half the clinics received an external subsidy; they were larger and had been running for longer than those without a subsidy. The most frequently mentioned reasons for deciding to work in a charitable clinic were a desire to serve the poor and improve society; to gain personal satisfaction; and a desire to help one's own community. To make best use of any indigenous professionals who do voluntary work for the poor, health planners should identify the number and type of charitable clinics in their area; provide them with small subsidies for essential drugs and equipment; publicize them to make sure they are well attended; and develop referral systems between charitable clinics and other local providers of primary healthcare.