Across Nepal, when you ask people in a tea shop, office, or out on the road about health care, almost everyone replies: "What we really need in our town is a doctor." What they should actually be saying is: "We really need an MDGP doctor."

Many young people all over the world want to become doctors. Nepal will soon be producing over 1,000 new doctors every year. But what kind of doctors does Nepal really need?

In Nepal a young doctor earns an MBBS degree, and follows that with a 3-5 year post-graduate specialisation to become a surgeon, pediatrician, obstetrician, internist, pathologist or radiologist. Specialised doctors are fine in their field, but aren't very competent outside their area.

MDGP doctors are specialists, but with a difference: they're all-rounders trained to be competent in each of the main medical fields. After a three-year course, they know how to care for children, deliver babies, perform essential operations, take care of sick adults with a variety of medical problems. MDGPs are the frontline primary care doctors in the cities and in the districts they are the life-savers.

General practice (or MDGP) training began at the Institute of Medicine in 1982, and was the country's first post-graduate doctor training. In the last six years, the BP Koirala Institute of Health Sciences and the National Academy of Medical Science (NAMS) have started MDGP training.

Nepal's MDGP program is a leader in South Asia, and even the Christian Medical College of Vellore gets academic accreditation for its GP program from Nepal's Institute of Medicine. Compared to general practice (or family medicine) doctors in the US or UK, Nepal's GP doctors are more skilled in surgical procedures, such as caesarean sections.

Because one MDGP doctors can cover a range of medical areas, they are the most appropriate for district hospitals across Nepal. In late 2007, when there was a hospital crisis in Dadeldhura the Health Ministry promptly transferred two MDGP doctors there. A dusty, old hospital, which was under-used for years, immediately picked up and started doing 40 deliveries and 30 operations a month.

Baglung used be a lonely government hospital that patients ignored, preferring to go to Pokhara for treatment. That was until Tarun Paudel arrived in 1999. This MDGP doctor helped transform Baglung into a model district training hospital where 800 babies are delivered every year and caesarean sections and other operations are regularly conducted.

Two years ago, the Sindhupalchok district hospital in Chautara was severely damaged in a fierce battle. The resident MDGP, Nanda Lal Sikarmi, survived the attack by hiding under a bed all night and stayed on to rebuild the hospital (see: 'Nepal's unsung heroes') and add new services.

In 2000, UNICEF adopted the Panchthar district hospital hoping to provide better care for mothers and children. It worked, and the main reason for the success was the dedicated work of one MDGP, Gunaraj Lohani.

Compare this to government hospitals where MBBS doctors are posted. Most cannot perform operations, conduct difficult deliveries, and they have to learn as they go.

Considering the medical needs of remote communities and the success of MDGP doctors one would expect that there would be hundreds of MDGPs all across the country by now. But there aren't, and the main reason is lack of recognition by the public and by the Health Ministry itself.

For most people in Nepal a doctor is a doctor, they haven't yet learnt what sets an MDGP apart. A community survey in rural Nepal showed that less than one percent of people had any idea what an MDGP doctor was. Only after a town actually has an MDGP come and work there do people realise the difference.

Harder to understand is why the government doesn't yet seem to see the need for MDGPs. The Ministry of Health and Population has a goal of providing emergency delivery services in all 75 districts. Today, while city hospitals regularly conduct lifesaving caesarian sections, less than 20 percent of the district hospitals do. One reason is the lack of MDGP doctors available to do this operation.

Another reason is that the Health Ministry still has no post for MDGPs and they are treated the same as basic MBBS doctors. As a result, fewer doctors want to enter this specialty. Government health services are like a three-legged stool: one leg preventive, one leg promotive, and one leg curative. In Nepal, the first two legs are reasonably strong. It is the third, curative leg of the stool that is weak, and without it patients in rural areas suffer.

Over the years, I have met and become friends with many doctors in Nepal. They range across all specialties and I know excellent doctors in many fields. Many are famous and admired throughout the country. But I have come to see that one real medical hero of Nepal has not yet been recognized: the MDGP doctor.

Mark Zimmerman is Director of the Nick Simons Institute in Kathmandu.