The D.C. Commission on Budget and Finance Priorities issued a much-needed call to rein in the size of the District's government this month. Unfortunately, its recommendations could threaten the health of the city's children.

Despite making "invest{ment} in children through improved education and health services" one of its four principal recommendations for Washington, the commission also recommended closing 15 neighborhood health clinics and replacing them with four comprehensive health centers. This move, in a time of financial trouble, would eliminate more than 1,400 positions in the city's health services and cut the health budget by more than $200 million across five years.

But more than money is at issue. The commission should have taken into account that:

A child born in Washington is more likely to die before its first birthday than a child born in Cuba, Costa Rica or Poland. The District's infant mortality rate is twice the national average. Black children are in even graver danger -- a black baby born in Washington is less likely to live until its first birthday than a baby born in Trinidad and Tobago or Panama.

One in seven babies born in the District has low birth-weight, the single greatest cause of infant death. While expensive technology -- costing as much as $1,000 per day in D.C. General's neonatal intensive-care unit -- can save many low birth-weight babies, those who live risk permanent disability. Prenatal care can prevent low birth-weight, yet barely half the expectant mothers in the District receive even minimally adequate prenatal care.

One in five children in the District has no health insurance.

The metropolitan area has one of the highest number of pediatric AIDS cases in the nation. Only five other cities have reported more cases of AIDS among children younger than 13.

The District's 15 neighborhood clinics are a front-line defense against illness and disease. They provide prenatal care, well- and sick-child care, immunizations, nutrition services and health education. They emphasize low-cost preventive services to try to avert high-cost hospital-based care. And because they are located in low-income communities, their services are readily available to families that need them. Low-income women and children rely on these clinics. For many, they are the only health-care option.

The District, however, has not invested enough in the clinics to fully meet the health needs of low-income children. Physical facilities are inadequate, crowded and depressingly drab. Because of staff and resource shortages, only 41 percent of preschoolers served in the neighborhood centers are fully immunized against preventable diseases; only one of five covered by D.C.'s Medicaid program actually receives preventive health services.

The glaring need to expand and improve health services for the District's children is obvious. And while it's true that the clinics are beset by problems, the health of the District's children would be even worse without them.

Four clinics simply would not be able to provide the same volume of care as 15.

Further, the commission's recommended budget and personnel cuts in a system that is already overwhelmed and understaffed would lead only to further deterioration in services to uninsured and low-income pregnant women and children. Families will become even more isolated from health care.

As mayor-elect Sharon Pratt Dixon reads the commission's report and considers her options, she should remember that the District's voters chose to clean house but not at the expense of the health of our smallest and most helpless citizens. It will be difficult to improve health services in such hard financial times, but D.C.'s children cannot stand continued neglect. The District needs more than four efficient and well-functioning clinics -- it needs 15 efficient and well-functioning neighborhood clinics.

Joseph Tiang-Yau Liu

is a program specialist with the Center on Budget and Policy Priorities, a nonprofit organization that analyzes public policies affecting low- and moderate-income Americans.