Wednesday, August 27, 2008

Uttar Pradesh: Corruption in public service promotes starvation and malnutrition

Uttar Pradesh: Corruption in public service promotes starvation and malnutrition

Dr Lenin Raghuvanshi 27/8/2008 4:19:11 PM(IST)

Case of three-year-old Pritam who died of malnutrition. Pritam suffered from malnutrition for seven months until he died. However, it is reported that the government authorities responsible for Pritam'''s death was not punished or even enquired upon by the government. The Ambedkar Nagar district authority further forcibly obtained a signature from Pritam's father in an attempt to fabricate documents to content that Pritam's family does not live below the poverty line.

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.

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.

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