Before we set aside malnutrition and child health as non-issues in the political sphere, let us understand that the GDP growth rate of the country lags behind by three to four percent because of this problem because owing to malnutrition, half of the populace in country becomes incapable contributor to the development and progress of nation with full vigour. The level of under nutrition affects the issue on which politics decides to go silent owing to compromise often becomes the “no action needed zone” for the bureaucracy.

Nine children died in duration of a week in three villages of Satna district of Madhya Pradesh due to starvation. The issue came to light when someone got wind of it. The health department says in its report that the deaths were due to malnutrition. However, the Women and Child Development Department (WCD) immediately denied the report, saying that the children had succumbed to various diseases, meaning it is not Dept’s responsibility. Only thing was found common during this period of more then 2 months, administration continued to deny the fact of Child deaths due to malnutrition, but on the other side, officials went to affected families and provided 65 KGs of grain. The question now emerges that if there are no hunger deaths, then why administration is distributing the food grain. The cost of a child death is worth 65 KGs grain in Madhya Pradesh!!

No responsible officer deemed it fit to visit the affected villages and the WCD Department managed to alter the report mentioning that the children were above six years of age and thus outside the purview of its care, Simple but pathetic.

Primitive Tribal Group in Gwalior-Chambal region – Saheriya, faces enormous health problems and while responding to these critical lives threatening conditions, State provides them – Dreams. In a very recent micro study by Saheriya Mukti Morcha, gives a bleak picture of state health services in rural areas. In a village – Chak Biledi of Sheopur district, in a period of 8 months (15th August 07 to 15th March 08), out of total 69 children under the age of 6 years, 13 have died due to preventable disease and 9 are girls among them. In the span of 35 days in June-July 2008, Karahal Community Health Center (according to NRHM guidelines CHC should have all facilities for deliveries) has just been referring the cases to District Hospital, which has resulted 5 women delivered their child in the buses. There is no body that has seen the ambulance under Janani Express Yojana, but hoardings of this scheme are there on each and every corner. The people’s organization Saheriya Mukti Morcha has filed 4 requests in last 4 months (April-July 08) to the district administration for organizing a health camp in the villages, but it couldn’t worked out, because government has yet to select the private agency, which will carry business contact for providing public health care in tribal areas. One word for it – Horrible!!

Three out of the four positions of doctors at the Community Health Center are vacant. There is no gynecologist or even women doctor. Karahal block officially has a mobile health van on the paper to reach out to inaccessible areas. There are just 166 beds in all the government hospitals to cover the population of 5.60 lakh in 533 villages. The supply of actually needed medicines is a big dream here.

Above all; there is no state health policy available in the Madhya Pradesh, there is a draft document for last eight years, but health ministry shown interest in making and finalizing medicine purchase policy first, as it has clear target to eat the money in a systematic manner.

Children are not looked upon as living being in integrated form but in piecemeal manner according to age, department and problems by the state. The issue is not confined to Satna. Nutritious food has not been delivered to 24000 Anganwadi Centers (AWC) in the State and 2lakh children are not getting nutrition, which is very essential for their survival. And this is a regular feature. Children continue to die, but surprisingly issue does not have enough edge to provide a basis for debate in the political circles. It also proves that the issues of malnutrition deaths are outside political priorities' list. The kindergartens have become very important for the affluent people and the AWCs are being demolished because the market forces do not want State to play any role as Child rights protector.

The meaning of the malnutrition in children is the starvation arising out of the political apathy towards the child rights, corruption, unaccountability and the current priorities of development.

It is important to note that about 16 percent of the population in state is below age of six years, which means that about 1.10 crore populace falls in this category, but only one scheme is being implemented for them. More shockingly, only 0.9 percent of the GDP is spent on children under-6.

Now market forces are looking forward to earn money from nutrition based welfare schemes in India. There is a strong pressure from the biscuits manufacturer lobby, under the banner of Biscuit Manufacturers Welfare Association (BMWA), on the policy makers in Government of India to introduce ready to eat food under Mid Day Meal scheme, and these market forces are arguing that locally procured meal will not be able to reduce / eradicate the nutrition deficiency among children.  Big companies are attempting to make 18 crore children of 14 lakh Government and Government added primary and middle schools their captive consumers through MDM scheme has come a cropper. You may be shocked by knowing the fact that more then 30 members of parliament are lobbying in favor of these companies and creating pressure on institutions like Prime Minister’s Office, Planning Commission and Ministry of Human Resource Development along with the Ministry of Women and Child Development. In this matter National Institute of Nutrition (authorized institution of Government of India on Nutrition) very categorically informed the Government (HRD Ministry) that Biscuits can not fulfill the recommended dietary requirements because biscuits are empty calories. At best they are snacks made of refined maida, sugar and hydrogenated fats, which can not replace a hot, cooked meal. More over 100 grams of biscuits provide only 6.5 grams of protein; this does not fulfill the nutrition norms. Adding 1, 2 or 5 micronutrients to biscuits may, in fact create problems because humans need at least 20 known vitamins, minerals and other protective substances, which can only be derived from fresh vegetables and fruits, and not from the added chemicals. Further more Minister of HRD, Mr Arjun Singh wrote a letter to these market advocate MPs that there is apprehension of violation of Hon’ble Supreme Court rulings that only hot cooked mid day meal is served.  The HRD ministry stopped it in Schools Women and Child Development Ministry is still standing with the Profit making companies. The question is who to believe in political sections? Even after the opposition from various important Government and Non-Government offices, Ministry of Women and Child development has sent a proposal for expenditure to Finance Ministry for the procurement and supply of Ready-to-Eat meal in ICDS at national level.

The extent of inhuman and apathy of our politics towards malnutrition and its victim children could be gauged from the fact that let alone implementation, even the basic structure of the ICDS (Anganwadi scheme) in the 11th five year plan (2007-12) has not yet been decided.

No sign of any progress in implementation could be seen in budget of 2008-09, probably because as per the wish of the Union Minister, the work of supply of nutritious food could not be handed over to private companies, which will provide Biscuits in meal, in place of hot-cooked and culturally acceptable nutritious food.

The Supreme Court of India, in a decision of December 13, 2006, had ordered the universalisation of the ICDS scheme. Till then only four crore children in country were benefited by the scheme and out of 14 lakh habitations, localities and villages, eight lakh do not have AWCs. The Supreme Court on in its order dated 28th November 2001 made it very clear that every child, pregnant woman, lactating mother and adolescent girl should have access to the Anganwadi centers and should get its benefits. This included nutritious food, health check up, pre-school education, vaccination and others facilities as provided by AWC. The order of the apex court mandated the State that the work of universalisation should be completed by December 2008.

However there is no political movement visible in this direction. No political party has taken this on its agenda. Lets take an example of MP, here only 67770 Aangawadis are being operational against the actual need of 1.26 lakh centers, while is dearth of as many as 58 lakh children are still deprived of the ICDS services. However one does not see any statement by any political party or either by any leader on the same.

We have seen those guidelines that mention the checklist for the ministers and bureaucrats should review during the visit to the field. But the issue is not of guidelines, but the ground realities and ground realities make it clear that neither the politicians, nor the bureaucrats make any effort to check functioning of AWCs. In fact they should be writing their comments on the Anganwadi registers, but a recent study of Right to Food Campaign finds not a single comment has being made by any of them till date.

The scheme basics make it very clear that every child, pregnant woman, lactating mother and adolescent girl should get the benefit of nutritious food and other services for 300 days in year without any limiting criteria. However in MP, the budget is given only for 130 days and out of this, the provision for 60 days fall victim to corruption. The report of Comptroller and Auditor General mentions that the scheme is not only prey to corruption in MP but also children do not get the necessary 300 calories and 8 to 10 gm of protein and as much as 59 pc children are totally deprived of the scheme. It is really a poser as to why the schemes in India are chalked out in a way that the common people cannot have any hopes from it. If one talks of government hospitals then they are centers that are filthy, totally degenerated with foul talking personnel and if one talks of Anganwadi centers then they are 8x10 ft rooms where 80 children, 20 pregnant woman and 30 adolescent girls are expected to sit. The beneficiaries are made to feel totally beggar-like during distribution of nutritious food so that they do not have any feel of being Rights Holder.

The controversy regarding the discrepancy and issues should not remain limited to statistics because the medical infrastructure in the state clearly reveals a far bleaker scenario. An analysis based on state government figures shows that one hospital bed is available for every two villages. There are 18 lakh births in the state every year and out of that 8.84 lakh births take place in poor families, but out of that only 3.5 lakh could be covered under the maternity schemes. And various macro studies show that the expenditure on health is a biggest cause of indebtedness among the tribal people.  The government provides only Rs 160 per person per year as health budget, of which Rs 126 is spent on salaries and other infrastructure costs.

In the collapsed health system even doctors do not want to work, interestingly in last 4 years average post of 39 CMHOs have been filled by in charge doctors, so that they could be exploited by the authorities. Only 137 posts of gynecologists and obstetricians are approved in the entire state, many of which were vacant for years. After a long battle, the government began the process of filling the vacancies last year: 78 posts of gynecologists and obstetricians, and 112 posts for anesthetists. But only 31 applications were received for the former and only 12 anesthetists’ posts could be filled.

Recent incidents, especially Income Tax department raids on top level health department officials and minister, shows the truth, shockingly an amount of 200 crore has gone into the pockets of officials and leaders. Corruption in sectors like Health and Women-Child Development is not merely an example of eating money by the authorities, but this corruption eats the Hundreds thousand lives every year, especially in the poor and the most marginalized sections of the society. One needs to co-relate the levels of corruption and bad health indicators.  Madhya Pradesh is the biggest contributor all together in Infant, Child and Maternal deaths in the world. Pervasive corruption at all levels is making conditions far more dangerous for pregnant women. This is partly rooted in the government's new policy of centralized purchase of medicines. As a result, most of the Rs 700 provided to a pregnant woman under the Janani Suraksha Yojana (Protection of Mothers Scheme) is spent on bribing the local health staff.  In these circumstances poor community is forced to opt the option of private health care, which limits the options of freedom in the life.

Despite unreliable data, government statistics show that out of 14.7 lakh maternal deaths and deaths due to reproductive health complications in the world every year, 97,000 are from Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, also known as the four BIMARU states, and the three newly carved ones of Jharkhand, Chhattisgarh and Uttaranchal. This figure has been corroborated by the World Health Organization (WHO). Half of the maternal deaths in south Asia are contributed by India's states of Rajasthan, Madhya Pradesh, Bihar, Uttar Pradesh and Orissa.

The worst luck is the fact that the development visionaries who consider Sensex and Gross Domestic Product as the most important indicator of Development feel that the governments need not to worry about the Hungry children, and even political parties should talk about the Growth based development, and should stop spending subsidies on issues like child protection. They should invest this money for Market development and their (State’s) subsidies to the Big Money Making Corporations will create employment and eliminate Chronic Hunger and all kinds of in-equality in the Society. Their argument that these schemes are waste of resources and it leads to the community becoming dependant on government and developing habit of eating out of spoon. They say that people should be taught to work hard, but forget that if one is afflicted by malnutrition in childhood and 80 pc of mental and physical growth is stunted and they cannot contribute to process of development in adulthood. In such situation, the development visionaries in the political lobbies would have to talk on child malnutrition as one of the major political issues, but the concern is that it should not be too late by time they decide to do so. Unfortunately MP could not get politicians like K. Kamraj or M G Ramchandran of Tamil Nadu, who considered nutrition of children as basic indicator of development and thus the ICDS, is one of the best run schemes in Tamil Nadu.

A debate is on over the issue but lack of political commitment is apparent. There is need for a comprehensive policy and coordinated effort for child and maternal health care instead of grandiose schemes to please the politicians. There is a need to make a call to the middle class of the society that they should not discard the need of public health services. It is very essential for the poor children today and they (children in middle class) will also need it badly tomorrow.

We should understand that principally we believe in a people’s democratic system, where any change can come through political process, but presently the system is becoming tolerant to the extent of being salient on the continuous child deaths.  The system is totally silent in political context on the issue of death of children due to malnutrition. Some violent protests are visible but majority of them are personal cases where some scenes are made in hospital premises when children from powerful families die, but it is limited to that. There is no demand or protest beyond that. The issue sometimes finds mention in comfort zones, some researchers and thinkers are working on it, but no political movement is visible on the issue. Children are dying to see their right to nutrition on the pages of election manifesto.

Sachin Kumar Jain