Denial as policy

The Maharashtra government refuses to acknowledge the fact that malnutrition-related deaths are widespread in the State.

THE malnutrition issue has to do with not only emaciated women with no control over childbirth and children with protruding bellies, but also unconcerned bureaucrats and politicians, the powerless poor who vote but cannot expect the rotting grain in State warehouses to be diverted to their homes and the citizen's groups and the courts that have been unable to ensure that the 300 million undernourished must be fed on a priority basis.

Malnutrition in India has behind it a story of bad governance. More than 50 per cent of the country's children and women are malnourished. Western democracies introduced reforms in their governance decades ago, whereas India is not even thinking about them. Poverty and malnutrition are bad words in their dictionaries.

In Maharashtra, an elected government refuses to acknowledge the fact that children are dying in the State because their calorie intake is poor. Gone are the days of PL-480 (Public Law 480 programme administered by the United States Department of Agriculture to provide food assistance to developing countries) of the 1950s and 1960s when our lifeline was in the custody of the U.S. and when delays in shipments would have caused food riotsin India. Gone are the days of large-scale starvation deaths. Instead, we now keep people miserably alive as undernourished citizens.

Unlike the killer human immunodeficiency virus (HIV), malnutrition might not cause death. It compromises immunity and increases the vulnerability to fatal ailments. This leaves room for governments and public health officials to argue that the cause of death was not malnutrition but poor hygiene, contaminated water, harmful cultural practices (inbreeding) and so on. Therefore, an acceptable methodology for establishing malnutrition-related deaths is to compare two populations. If the one with a higher rate of malnutrition also has a higher child death rate, it can be concluded that the deaths are malnutrition-related. Had malnutrition not prevailed, the rates of death would have been lower.

As the Commissioner of the Tribal Research and Training Institute, Pune, I prepared three reports on the basis of small, quick surveys in 2002. The third report compared malnutrition and child mortality rates in the State with those in five villages and indicated that the higher death rate in the villages was because of the higher malnutrition rate. The findings are given in the table.

The reaction of the government to the report was shocking. I was issued a "show-cause notice" on September 12, 2002, for contradicting the government stand that the deaths were not the result of malnutrition and was asked to give reasons why disciplinary proceedings should not be started against me. The notice, signed by the Chief Secretary, stated that I had briefed the press in spite of the fact that the Ministers of Public Health and Tribal Welfare had declared to the media that the deaths were unrelated to malnutrition. The notice was not concerned with the findings or analysis in the report but was obsessed only with the government being contradicted.

The Chief Secretary told the press that the children could not have died of malnutrition because the fair price shops under the Public Distribution System were well stocked with foodgrains. The question is: Did the poor have the purchasing power to gain access to the grain in government shops? The denial of malnutrition-related child deaths was illogical and arbitrary and designed to conceal the truth. It showed the absence of commitment and sensitivity in the bureaucracy and even the political executive elected from rural areas and charged with the responsibility of implementing the anti-poverty agenda in a welfare state.

And for this conduct there is no accountability. I prosecuted the Chief Secretary and others for abuse of authority, providing false information to the political executive despite the documented evidence for malnutrition deaths, breach of trust in not starting Employment Guarantee Scheme (EGS) works in the poverty-striken areas and so on. But the court quashed the complaint. The complaint had stated that the stand of the Chief Secretary and the Ministers "would cause injury to the weaker and malnourished sections of society by concealing their true and real economic and health situations. This in turn would reduce the public focus on their situation and deprive them from the enhanced funding they could have received for their welfare had their true condition been exposed to the public, the media, policymakers, and those who can influence policymaking". It allayed that the Chief Secretary had "destroyed the requirement of free and impartial investigation in public matters by issuing his false declaration and silencing difference of opinion by issuing a show-cause notice to the complainant. This injures the State as well as the research institutions, doctors, public at large by destroying the independence of research institutions, especially those dealing with public affairs, like the institution for which the complainant works. This also blocks accurate feedback for policy making."

The surveys had concluded that 56 per cent of the deaths were not even reported by the government.

The surveys also revealed that the target group of the poor were not offered any work under the EGS; that they were unaware of their right to employment under the scheme; that there was a great demand for work in the villages; and that for six months they had lifted only 50 per cent of their foodgrain quota from the fair price shops because they did not have the cash to buy grain even at the subsidised government rate.

Distributing iron tablets and vitamin supplements is not enough. Distributing small amounts of cash (Rs.200) to pregnant women is not enough either, for its utilisation within the family is not monitored.

A comprehensive poverty eradication programme needs to be put in place, which would include land distribution and generation of rural employment. The rampant corruption in the EGS, which is meant to provide rural jobs, needs to be removed by using participatory monitoring tools and an independent physical audit. The decision of the government to implement the scheme on a national scale is sensible and should have been made decades ago.

However, the debate on the EGS has taken a peculiar twist. Suddenly, the focus is on corruption. The scheme is under attack because it is susceptible to corruption and it is argued that it will facilitate the flow of funds for the poor into the pockets of bureaucrats and politicians.

In a country soaked in corruption, this is comical. The scope for leakages is far greater in large capital-intensive schemes such as road or dam construction. These account for large chunks of State and local budgets. The rate of corruption is 30 per cent on the basis of conservative estimates.

A quick inspection of seven rural schemes (other than roads and large dams) done in 2002 revealed a corruption rate of 50 per cent. But corruption does not agitate those who are in a position to initiate change, nor is it seriously discussed. In my 30 years of government service, it was never on the agenda at any meeting. But when we talk of allocating money for the poor we develop a concern for corruption.

Arun Bhatia is a retired Indian Administrative Service officer. His last posting was as the Commissioner of the Tribal Research and Training Institute in Pune, where he published a document exposing malnutrition-related deaths of tribal children in Nandurbar and Thane districts of Maharashtra.