Janakpur displays the symptomatic extravagance of a settlement that brought in new money. Most SUVs parked along major arteries are owned either by provincial ministers or by mayors neighboring municipalities. Motorcycles of political party executives, many masquerading as journalists or NGO entrepreneurs, fill the narrow streets that are home to exotic eateries serving spicy and spicy food at all hours of the day. Confectionery stores sell mithai mainly from refined wheat flour. Stalls around the corner that once served betel leaf preparations are making more money these days by handing out sachets of chewing tobacco, bottles of sweet cola, fruit soda in sachets. of tetra and packets of instant noodles. Dump trucks carrying crushed stone, sand, bricks, cement and rebar speed past leisurely pedestrians. Vendors who sold assorted grains and vegetables in bamboo baskets were driven from the main roads into the alleys.
Rampant exploitation has pushed groundwater levels down. The drop in water level has intensified the land sagging. For inexplicable reasons, land prices in Janakpur are higher than in Birgunj or Biratnagar. Perhaps this is the reason why residential houses rarely leave enough space in the front yard to plant a mango tree or maintain a flower bed. However, the most alarming construction practices can be seen in the construction of for-profit hospitals in the densely populated city center of Janakpur within Parikrama Sadak.
Once called rice bowl, breadbasket, legume pot and fruit platter all at once, the plains of Bagmati, Rato and Kamala are still as fertile as ever. But agriculture is no longer as remunerative as it once was due to more expensive inputs, stagnant commodity prices and lack of investment in modernizing agricultural technologies and irrigation facilities. Since the late 1990s, remittances have helped the region’s economy shift from agricultural production to consumption of basic consumer products and essential services. By the early 2000s, the so-called “boarding schools” had become a thriving business even in small villages. However, demand for consumer goods has now leveled off. The families of remittance recipients began to realize that the return on investment in their children’s education reached a point of diminishing return after ten years of schooling. it’s a lot more sense to obtain a passport when a person becomes eligible for the citizenship certificate than to spend time and money in acquiring higher education.
Savvy investors have discovered an even more lucrative avenue for their money, the so-called health care industry. An increase in the number of households receiving remittances and a slight increase in family incomes as more members move to work abroad means that a large class has emerged with the means and willingness to spend. for the health of their wives, children and the elderly. With increasing life expectancy and increasing awareness of prompt treatment, the demand for health care is increasing. The industry’s offer reacted eagerly.
The Janakpur Cigarette Factory has closed for good. Once flourishing, the city’s rice mills have practically disappeared. Even more recent maida factories have closed shop. The civil service in the formal sector and the construction industry in the informal sector remain the two largest employers. For third place, there is close competition between the education and health sectors, the latter having less regulatory control, higher possibilities for expansion, more profitability, better social acceptability and greater professional respectability.
Janakpur appears to be in the throes of a hospital building frenzy. New buildings around Rangbhumi lots that look like hotels or malls from the outside turn out to be for-profit hospitals. Hoteliers are diversifying into hospital activities. Shutters and storefronts that once hosted Kathmandu doctors on weekend trips to their local clinics have started to transform into full-service treatment centers with pathology and radiology departments. Until the 1960s, Baidya-Ji Ayurvedic Dispensary in Suga Village near Janak Temple was where everyone went for primary health care: consultation was free and medicine cost a pittance. . Dr Jay Ballav Das had brought allopathic medicine to town with his clinic near the railroad tracks in the mill area. He did not have a fixed fee and patients were free to offer whatever they saw fit; he earned his living from his services to the employees of the cigarette factory.
When public service sectors such as banking, education, and health were opened up to private investment in the mid-1980s, Janakpur saw its first for-profit hospital euphemistically called “nursing home.” The very profitable disease industry hasn’t looked back since. The complex world of treating the sick operates on several levels. The government funds and operates primary health care centers, district hospitals and provincial referral hospitals. The private for-profit sector began to dominate the treatment industry through its network of touts, paramedics and pharmacists in the countryside. No charity runs a hospital anymore. There are cases of NGOs, civil society organizations and development agencies maintaining health facilities for the poor in several developing countries. They don’t do it here, leaving the field open to the inefficiency of the government and the insincerity of the for-profit sector.
The modus operandi of health care providers is profit at all levels. Pathology, radiology, expert consultations and pharmaceutical products bring the money. Surgical interventions bring more moolah. Referrals to larger hospitals in Kathmandu, India or overseas guarantee lucrative commissions. The cost of operating a hospital is high, but the market is large and the clientele can be further increased with the addition of training centers for nurses and paramedics. The pandemic has shown that for-profit hospitals are of little use in increasing public health services. Charitable trusts may be able to fill the void, but the concept of corporate social responsibility often means respectable means of reducing the tax burden.
The Madhesh Academy of Health Sciences is still in its infancy. While such an initiative will certainly help improve the quality of health services, which most of Nepal will continue to need for the foreseeable future, they are more barefoot doctors bring their services to people’s doors. By the time a patient leaves the home, the chances of them falling into the net of the treatment industry increase. The tentacles of the processing industry are in dire need of clipping, which can only be done by improving the service delivery capacity of the public sector.