IN FISCAL YEAR 1983, the public's use of District government health clinics peaked at 343,600 visits, according to city statistics. By FY 1989, there were only 236,700 visits, a decline of nearly 28 percent. Most recently, city clinics have suffered a severe erosion of staffing and resources. Sometimes they lack the most basic medical and clerical supplies. It's a pattern that bodes ill for the health status of many D.C. residents, who often wind up in hospital emergency rooms for illnesses and conditions that could have been managed or prevented.

That's why the city's other public health system is tremendously important. It's made up of clinics run by nonprofit groups that raise their own funds or work in partnership with the D.C. government, treating poor people who have little or no health care coverage. They have helped reduce the city's costly burdens, as well as those of private hospitals, which have provided much care for indigent residents.

Two notable examples are the Zacchaeus Clinic at 1329 N St. NW, which has offered free care to the homeless and working poor since 1974, and Mary's Center for Maternal and Child Care, located in Adams-Morgan. Zacchaeus, according to one official, receives most of its funds from individuals and from the United Black Fund. It handles 4,000 patient visits a year by using volunteer doctors, nurses, midwives, physician assistants and premedical students.

Mary's Center for Maternal and Child Care has received national praise; its aim is to treat patients "with dignity and respect." It has responded so well to a difficult population -- mostly Hispanic refugees who may never have seen the inside of a hospital -- that its pregnant women average 13 prenatal care visits. Midwives also perform home visits after a mother has given birth. Mary's Center serves 450 women patients and about 1,380 children; its midwives delivered 191 babies last year. Much of its funding comes from the D.C. government, although it has also received a $550,000 federal grant.

The D.C. government's health system faces an uncertain future. City health clinics fall under the aegis of the city's Department of Human Services, which now accounts for nearly half of the city's projected budget deficit. D.C. officials are now mulling over the possibility that some clinics may have to be closed and consolidated. Some private hospitals say they may be forced to curtail some of their efforts. This simply means that facilities such as Zacchaeus and Mary's Center will be even more important in the future. They are providing an invaluable service to city residents who cannot afford the high costs of health on their own.