This paper reports on a study of the organizational effectiveness of small human service organizations serving indigent clients. Four important organizational activities of public health clinics were evaluated, namely providing services acceptable to clients, obtaining and retaining clients, resolving tension and conflict among the members of clinic staff, and maintaining organizational flexibility. Within a goal framework based on the dual-goal concept, the activities were identified either as externally -or internally-oriented goal activities. The extent to which the clinics carried out these activities was investigated by administering questionnaires to 709 indigent clients and 133 members of clinic staffs at 18 clinics. Findings concern the attainment of organizational goals, the interrelatedness of achievements of various effectiveness measures, and structural and human characteristics of the clinic organizations associated with the achievements.