[Hunger Alert] GENERAL (India): Corruption in public service promotes starvation and malnutrition in Uttar Pradesh

26 August 2008
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INDIA: Corruption in public service promotes starvation and malnutrition in Uttar Pradesh

ISSUES: Right to food; malnutrition; hunger death; corruption
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CASE DETAILS:

As mentioned in the AHRC's previous urgent appeal, three-year-old Pritam died of hunger on 24 November 24 2007. Pritam was diagnosed as suffering from Grade IV malnourishment (Protein Energy Malnutrition; PEM) and Pneumonia at the Ashopur Primary Health Centre (PHC, register No. 9579) of Tanda Block, Ambedkar Nagar district, on 13 April 2007. Three-year-old Pritam weigh only 5 kilograms at that time. (Please see further: UA-333-2007)

After Pritam's death, the local human rights activists led by the Savitribai Phule Women's Forum made lots of efforts to examine the cause of Pritam's death so that no other child would die in similar circumstances in the future, and to support Pritam's family.

It was reported that these efforts led to the proposal to hold a hearing in which the government officials including the Director of Child Development Service and Nourishment, the Secretary of Women and Child Development Department, the Chief Secretary of Family Welfare Department, the District Magistrate of Ambedkar Nagar and the Chief Medical Officer of Ambedkar Nagar, and Mr. Raj Karan, Pritam's father, were supposed to attend. Mr. Prabhat Kumar Srivastava, the Under Secretary of Uttar Pradesh state government sent a letter informing the above persons about the hearing and requesting their presence for the hearing to be held on 22 May 2008.

According to this letter, Mr. Chandra Prakash, the Director of Child Development Service and Nourishment insisted that Pritam's death should be investigated by the Assistant Director-Head Quarter Mr. Saheeb Singh. It is mentioned in this letter that on 8 April 2008, an Investigation Officer submitted a report stating that the complaint regarding Pritam's death was neither justifiable nor acceptable.

During the hearing and after, the facts below were reportedly discussed and confirmed.

Ms. Shubhawati Verma, an Anganwadi worker (Child Care Centre staff) of Alhadadpur village identified Pritam as a Grade IV malnourished child and referred Pritam to the Ashopur PHC in April 2007. Shubhawati also took Pritam to the Community Health Center (CHC) of Tanda Block to register Pritam as a malnourished child (register No. 10139). It is found in the medical report at the PHC and CHC that Pritam was merely provided with polio immunisation.

On 1 September 2007, the Child Development Project Officer of Tanda Block submitted an investigation report that Pritam was suffering from Grade IV malnutrition after visiting Anganwadi Centre at Alhadadpur village.

Since then, Shubhawati provided nutrition to Pritam and on 1 October 2007, reported Pritam's health condition to Mr. Sangram Verma, village head of Gram Panchayat, Arkhapur-village council, of Alhadadpur village. However, the village head did not take any action for Pritam, which aggravated Pritam's malnutrition. The village head of Alhadadpur village's corruption and negligence, in particular concerning the Dalit communities has already reported the case of Pritam.

Even after Pritam's death, some government officers visited Pritam's house and forcibly took Pritam's father Raj Karan's signature on the paper stating that the family have a buffalo and other business for a living. It is alleged that the officers intended to prove that Pritam's family does not live below the poverty line although they had an AAY ration card (ID No. 35325) for the poorest in the village.

ADDITIONAL COMMENTS:

The Pritam's malnutrition and death resulted from the failure of entire health care system caused by the negligence and corruption of the relevant government agencies.

The health care in India, in particular for children and women is to be covered by the Integrated Child Development Scheme (ICDS). This scheme is in operation since 1975. The scheme is implemented through the Anganwadi Centre (AWC; child care centre) at the village level in rural areas. Further the National Rural Health Mission of India (NRHM) launched in 2002 supplements the work of the AWC.

The NRHM is designed to provide public health services to the villagers ranging from village level to state level. To make this system deliver expected or projected results the relevant government agencies responsible for the implementation of the NHRM schemes must function in a coordinated fashion. Pritam's death and the subsequent reactions of the government agencies as illuminated from the facts of this case exposes the malfunction of the government agencies, in particular at village level. The village level government agencies like the village head, AWC etc. and their proper functioning are the essential and elementary requirements to prevent hunger and malnutrition.

The role of these government agencies and local bodies like the village head or the village panchayat is not to attend to an issue when a problem arises. As always prevention is better than cure. Unless the rural and grass-root agencies function in such a manner to first identify the cause of starvation and malnutrition, which includes the socio political structure in a given rural society, none of the government schemes can deliver result.

At village level, the village council working for the villagers' welfare and development, along with some other health workers such as Accredited Social Health Activist (ASHA), AWC workers, and Auxiliary Nursing Midwife (ANM) is primarily responsible for precaution and relief from malnutrition and hunger.

According to the ICDS, the AWC for Alhadadpur village is supposed to provide vaccinations against poliomyelitis, diphtheria, tetanus, tuberculosis, and measles for the children below age six. The AWC for Alhadadpur village, however, reportedly merely provided poliomyelitis vaccine in Pritam's case. This deficiency of primary immunisation for infants and children easily gives the space to suspect that other health facilities and supply at the AWC for Alhadadpur village are not sufficient for the children to be free from malnutrition and hunger death.

When the AWC worker of Alhadadpur village reported Pritam's health condition to the village head, the village council including village head, village secretary, and revenue officer (Lekpal) were unconcerned about the issue. Although the nutrition was provided to Pritam for a while, no further action by the village council was taken for Pritam, which resulted in his death.

In addition, according to the Convener of Savitribai Phule Women's Forum Ms. Shruti, the Auxiliary Nursing Midwife (ANM) working in Alhadadpur village did not take further steps to rescue Pritam from malnutrition. The ANM is the key health worker at the village level interacting directly with the community and the training of ASHA and AWW staff. The ANM attached to the health institution such as the PHC, CHC or sub-centres have been playing a multi-functional health worker role since 1973 providing family planning, immunisation, sanitation, infectious disease prevention/care and delivery care.

The village council did not take any action to save Pritam from malnutrition which violates the guideline of state government for assistance to the people struggling against the malnutrition and hunger. The National Guidelines on Infant and Young Child Feeding initially released in 2004 also states that mothers of malnourished children could be invited in a camp and be provided with a fortnight's ration of roasted cereal-pulse mixes with instructions. The condition of the children could be followed up every fortnight for growth monitoring, health check up and supply of instant food ration for a period of three months.

On the contrary, the officers forced Pritam's father to sign on a paper stating false living condition of the family. This apparently illustrates that the local government authority attempts to conceal the fact that Pritam died of malnutrition under the poor living condition. The officers' behavior infringes the Scheduled Caste and the Scheduled Tribe (Prevention of Atrocities) Act 1989 (SC/ST Act).

The Section 3(1)(ix) of the SC/ST Act states that 'Whoever, not being a member or a Scheduled Caste or a Scheduled Tribe, gives any false or frivolous information to any public servant, and thereby causes such public servant to use his lawful power to the injury or annoyance of a member of a Scheduled Caste of a Scheduled Tribe; shall be punishable with imprisonment for a term which shall not be less than six months but which may extend to five years and with fine.

Pritam's family belongs to SC community (Dalit) in Alhadadpur village. The family is the one of the SC families who lives below the poverty line (BPL) in the village. Officially, there are 90 families living BPL in Alhadadpur village, of which 65 families belong to Scheduled Caste community. As even the official index shows, most of the BPL families in the village belong to the SC. The economically poor and socially marginalised SC members in the village are easily discriminated by upper caste group mainly occupying the official position such as village council. Pritam's death followed by Juli's death (please refer to previous Hunger Alert case, HA-005-2007) in Alhadadpur village explains the failure of public health care caused by the corruption and enjoyment of caste discrimination by government servants in India.

SUGGESTED ACTION:
Please write to the government agencies listed below to express your concern about this case.

The AHRC is writing a letter to the UN Rapporteur on Right to Food and Right to Health respectively calling for an intervention into the case.

SAMPLE LETTER:

Dear __________,

INDIA: Please take immediate action to prevent further deaths from malnutrition in Uttar Pradesh

Name of victims:
1. Pritam, three years old, son of Mr. Raj Karan, Alhadapur village, Tanda Block, Ambedkar Nagar district, Uttar Pradesh, died of malnutrition on 24 November 2007
2. Mr. Raj Karan, a resident of Alhadapur village, Tanda Block, Ambedkar Nagar district, Uttar Pradesh, threatened and forced to sign on false statement by government officials
Place of incident: Alhadapur village, Tanda Block, Ambedkar Nagar district, Uttar Pradesh, India

I am writing to express my concern about the repeated incidents of child death in Uttar Pradesh of India from malnutrition. I am aware that two children died from malnutrition in Alhadapur village, Tanda Block, Ambedkar Nagar district, Uttar Pradesh in 2007. I am informed that no government authority has effectively responded in these two cases. On the contrary, they are trying to cover up the case.

It is reported that the official record of the Primary Health Centre (PHC) and the Community Health Centre (CHC) for the village apparently shows that three-year-old Pritam died of malnutrition and pneumonia. However, the investigation report conducted by the Assistant Director - Headquarter insists that the complaint regarding Pritam's death is neither justifiable nor acceptable.

It is also reported that after Pritam's death, the local human rights defenders led by the Savitribai Phule Women's Forum made efforts to examine the cause of Pritam's death so that such incidents would not recur. This effort led to convening of a hearing on May 22, 2008. The Director of Child Development Service and Nourishment, the Secretary of Women and Child Development Department, the Chief Secretary of Family Welfare Department, the District Magistrate of Ambedkar Nagar and the Chief Medical Officer of Ambedkar Nagar, and Mr. Raj Karan Pritam's father were supposed to attend. Mr. Prabhat Kumar Srivastava, the Under Secretary of Uttar Pradesh informed the above persons about the hearing through a letter.

I am informed that during and after the hearing, several facts regarding Pritam's death were discussed and confirmed. The village council of Alhadapur village including the village head and the village secretary did not take appropriate action to release Pritam from malnutrition even after they were informed about Pritam's health condition by the child care centre (Anganwadi Centre) worker. In particular, the village head Mr. Sangram, is reportedly corrupt and prevents the food grains from being distributed to the poor. The grain stock is sold to private restaurants through the black market.

I am further informed that Auxiliary Nursing Midwife (ANM) of the village did not discharge her duty properly.

I am aware that for the public health system such as National Rural Health Mission of India or the Integrated Child Development Scheme (ICDS) to function properly, the village council is one of the most essential organs. I have also studied that the ANM is the key health worker at the village level, interacting directly with the community and training ASHA and AWW as assistants. It is also reported that the child care centre of the village merely provided polio vaccine against six assigned vaccines for the child.

I am of opinion that all these inaction and corruption resulted in the Pritam's death and the malfunction of public health care. However, no disciplinary action was taken against the public servants who contributed to Pritam's death. This impunity encouraged the officers to force Pritam's father to sign a false statement regarding their living condition.

I therefore, urge you to intervene to ensure that the public health care system work properly in Uttar Pradesh so that similar deaths doe not recur.

I also urge you to intervene in this case and enquire about the conduct of the relevant public servants including the village council members and the ANM who are directly involved in this case. Furthermore, the officers who forcibly obtained a signature from Pritam's father should be punished.

Yours sincerely,

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PLEASE SEND YOUR LETTERS TO:

1. Ms. Mayawati
Chief Minister
Chief Minister's Secretariat
Lucknow, Uttar Pradesh
INDIA
Fax: +91 522 2230002 / 2239234
E-mail: csup@up.nic.in

2. District Magistrate
Ambedkarnagar, Uttar Pradesh
INDIA
Fax: +91 542 250 1450
E-mail: dmamb@up.nic.in

3. Minister of Women & Child Development
Government of India
Shastri Bhavan
New Delhi
INDIA
Fax + 91 11 23074054
E-mail: min-wcd@nic.inm

4. Director
Department of Women Welfare & Child Development
Government of Uttar Pradesh
Jawahar Bhawan, Ashok Marg
Lucknow, Uttar Pradesh
INDIA
Fax: +91 522 228 6140

5. Dr. Anbumani Ramadoss
Minister of Ministry of Health & Family Welfare
Nirman Bhavan
Maulana Azad Road
New Delhi - 110011
INDIA
Fax: +91 11 2306 1751
E-mail: hfm@alpha.nic.in

6. UNICEF
73 Lodi Estates
New Delhi 110 003
INDIA
Fax: + 91 11 2462 7521 / 11 2469-1410
E-mail: newdelhi@unicef.org

7. Regional Director
World Food Programme
Unit No. 2, 7th Floor, Wave Place Building
55 Wireless Road
Lumpini, Patumwan
Bangkok 10330
THAILAND
Fax: +66 2 655 4413

8. Country Director
World Food Programme
2 Poorvi Marg, Vasant Vihar,
New Delhi 110057
INDIA
Fax: +91 112 615 0019
E-mail: wfp.newdelhi@wfp.org

Thank you.