Abstract
This article describes the response of the Yala Urban Health Programme and its predecessors to urban health problems in Patan, Nepal, over 20 years. The initial response was to take responsibility for filling the gap in essential services; however, since 1998, the response has changed, to become an eight-year phased transfer of responsibility to local government, with the following goal: “To improve the health of all in Patan, particularly the poor and marginalized, by establishing an effective, accessible and sustainable primary health care system. This will be a public–private–NGO partnership coordinated by the city council.” Six years into the process, there are encouraging signs that local government will indeed take up the challenge of coordinating essential health services for the city. We describe here the factors we believe have contributed to a successful handover, some of the problems encountered so far and the uncertainties that remain. Perhaps the most important factor for success is that leaders in the international NGO and the municipality have been willing to take risks. By modelling an attitude of service and valuing the service given by others, the balance of risk may have been tipped in favour of success.