Hunger-related deaths among children continue to afflict the tribal population of Sheopur.

"The tribals need to change their attitude and lifestyle," said R.K. Dixit, the Chief Medical Health Officer (CMHO) of Sheopur district in Madhya Pradesh, in response to a query about continuing reports of children starving to death in the region. The Sahariyas, one of the poorest tribal communities in Madhya Pradesh, live mostly in remote villages with little access to health care. Undoubtedly, they would like to change their lifestyle - to begin with, they would like to eat two square meals a day. 

Since Frontline reported 13 hunger-related deaths in Patalgarh village in February 2005, there have been similar deaths in at least two of the four villages this correspondent visited this year in the same district. But, just like last year, local officials continue to seek refuge in denial. They deny that acute hunger is a problem. They insist that existing government schemes are being implemented properly. They deny that anything more could have been done. 

Hunger deaths are a sore spot with officials in Sheopur. Bring up the subject and official responses range from "it is their culture" to "they don't care about children dying; they have so many that they don't even remember" to "they're accustomed to hunger now" or "it wasn't really starvation... maybe some underlying malnutrition". When he was asked for the total number of malnourished children in the district, Dixit told this correspondent to consult the civil surgeon. The civil surgeon's office was found locked. 

Not so remote, but starving 

Karrai village in Karahal block was in the news recently after five children died. When Frontline visited the village, its residents spoke of seven deaths in July. Kishen's three-year-old daughter, Karan's four-year-old son, Heera's three-year-old son, Ramhit's one-year-old son, Laddoo's infant daughter, Jagram's seven-year-old daughter, Harvilas' one-year-old son. All of them appeared to have succumbed to fevers, coughs, measles, or something else that they did not know the name of. But looking at the surviving children's distended bellies, protruding eyes and wasted limbs, there can be little doubt as to what, at root, is wrong with their health. 

Two other children were dangerously sick and were hospitalised at Sheopur. Hari Sahariya's son Gajraj and daughter Ramdhara are both very fragile, but at least they are alive. Hari told Frontline: "I stayed for 10 days at the big district hospital. But there was no money. The children were fed, but not us. How could we have stayed on longer?" 

Hari does not know what is wrong with his children, but the medicines prescribed offer a clue - they are all vitamin or mineral supplements. It seems that all the children needed was better food. 

Karrai is not particularly remote. The village is barely two minutes from the main highway. It even has a health centre, an anganwadi and a school. When asked if the school gives mid-day meals regularly, a student, Chatru, nodded uncertainly. "Sometimes, yes. When the master comes, there is food. The master comes after every two days." 

The smallest children get a fistful of panjeeri (a roasted mixture of corn, soya, sugar and oil) at the anganwadi centre every day. But infants who are too small to eat are particularly vulnerable. Draupadi, a mother with a baby in her arms, said, "What can these little ones eat? If we eat, they'll drink some milk." 
Several newborns go hungry since the mothers have not eaten, and mothers are forced to keep the babies alive by making them lick a little jaggery. 

The other problem with the way the anganwadis handle malnutrition is that the registers are not maintained properly. The worker does not seem to know precisely how old the child is and therefore cannot judge how severe its condition is. Usually, malnutrition is measured against a chart balancing height and weight parameters; but because malnourished children are often stunted, it becomes impossible to assess whether they weigh enough unless age is taken into account. However, there are few birth registrations and the people, being illiterate, do not keep personal records. It is very important, under the circumstances, that the anganwadis keep a record of birth along with that of height and weight gain. 

Uma Chaturvedi, a fellow with the Right to Food campaign who has been working in Sheopur for two years, says this is a significant problem: "The anganwadi registers are ill-kept. The weight and grade [of malnutrition, which is judged in grades of severity from 1 to 4] columns are often left blank; many column entries are completely bizarre. For instance, there was one entry in the name of Priti, daughter of Ghamandi. Between February 2003 and December 2004, the child was given seven different dates of birth. Between December 2004 and June 2005, no entries were made at all. How can one child be born seven times and how can she grow younger as time passes? How will you judge her level of malnourishment correctly then?" Uma Chaturvedi found at least 20 such cases of bungled age entries in the anganwadi centre of one tiny hamlet, Kishanpura. 

According to officials, the anganwadi centres alone cannot be blamed for they are not equipped to deal with hunger on such a large scale. Sheopur's ICDS (Integrated Child Development Services) officer O.P. Pande told Frontline: "We are supposed to provide supplementary nutrition. For example, we can give about 300 calories worth, of the total requirement of 1,200. But if the child is entirely dependent on this small supplementary meal, it is bound to be malnourished." 

Nevertheless, one cannot ignore the fact that in some villages, anganwadi services are either absent or only partially functional. In Patalgarh, despite assurances and visits from officials, the villagers say that at least eight children have died since the 13 deaths reported in February 2005. It was only in May that the village got a functional anganwadi centre. The village still has no midwife, no medicines and no nurse; the anganwadi worker does not have the skill or resources to help with deliveries or provide pre-natal care to women. There is one male "multi-purpose" health worker in the area, but he is responsible for three panchayats and would not be able to assist in childbirths anyway. 

The result is that many children die as soon as they are born, while mothers frequently die during childbirth. Gokul's wife Bhagwati died on the road while he was trying to get her to a hospital 70 kilometres away on his bicycle. The newborn baby died as well. Gokul is now left to care for three other young children and his aged mother. 

In another such case, a woman called Kalli was saved with great difficulty. Right to Food activists happened to be in the village when she was in labour and managed to take her to the district hospital in a car. 

Recently, residents of the village signed an affidavit complaining of misbehaviour by district officials. When Kalli's newborn died and her life seemed to be in danger, they called up the CMHO, the District Collector and the Deputy Collector of the block, asking for a car or an ambulance to be sent urgently. The then CMHO allegedly told them that if they could not make it to the hospital, they could not hope to get medical assistance. The (former) Collector allegedly hung up on them. The SDM claimed to have sent a vehicle but it never arrived; later, when they confronted him with this fact, he allegedly told them not to talk back. 

Patalgarh has other problems to contend with. Under the National Rural Employment Guarantee Scheme (NREGS), the villagers were given the work of digging and building roads. Almost all families have job cards. According to the entries on the cards, many families have already got more than 100 days of work over the last three months, though most of them have worked for between three and seven days only. But with mechanical regularity, the cards proclaim that the card-holders worked for six days a week, week after week. 
Santosh Sahariya, who is literate, says that he worked for only six days but his card mentions 36 days. Besides, he was engaged in digging a pond, while his card entries claim that he worked on road construction. Residents say their cards were taken away by the `contractor', sometimes without their permission, and the entries were made without their knowledge. Most of them are illiterate and do not know what the cards say. 

When questioned about these fake entries, the district panchayat chief, Shyam Singh, told Frontline that he had visited the village along with the Collector and no such problem had been mentioned. He added that a lot of people worked on both projects, the pond and the road, working through the day. When it was pointed out that the villagers denied having worked more than a few days, he said, "Come back with an appointment." When asked if it would be possible to obtain a list of all NREGS projects currently under way in the district, he said, "Ask the Collector." 

The Collector, M.S. Bhilala, was not available for comment. 
The problem of hunger is, of course, directly linked to the problem of acute poverty, ration distribution and employment guarantee. Madhya Pradesh has a dubious record there. Food and Civil Supplies Minister Gopal Bhargava recently went on record as saying that at least 54 per cent of the BPL (below poverty line) ration cards in the State had been found to be fraudulent and fresh cards would have to be issued. 

The new list that was drawn up and implemented this year (based on a 1998 survey) seems completely irrational. Many poor families have been struck off the list. In Rohni village, for instance, only four families have been given yellow ration cards, which certify them as being BPL. Gaya Khushwah, for instance, is a landless widow. She is not certain how old she is, but looks older than 80. Her ration card, however, mentions her age as 40. She gets neither the old-age pension nor the widow's pension and now her name has been struck off the BPL list. Radha, another landless widow who must also be at least 80 years old, has been struck off the list too. Some old people did not have ration cards at all, and most of the families did not have job cards or health cards either. 

One little step, not enough 

It is not as if the government is not making any attempts to tackle hunger and poverty. It introduced the Bal Shakti Yojana in August 2005. Under this scheme, if a severely malnourished child is brought to hospital, he/she can be admitted for up to 14 days and provided food worth Rs.15 every day, including high-protein soya biscuits and milk. In addition, the mother is also entitled to Rs.35 a day, to enable her to eat and stay with the child. She also gets Rs.100 as mobility (transport) allowance. The wards or centres for malnourished children are called Poshan Punarvas Kendras (Nutrition Rehabilitation Centres) and local officials have the freedom to take the help of local non-governmental organisations (NGOs) or community organisations to establish bigger centres with better facilities. 

In Sheopur, the first Nutrition Rehabilitation Centre has been set up in the district hospital, as a separate ward. Dixit said that it was launched on July 30 but so far no one to cook and so the children were being given soya biscuits and milk. He added that the mothers had been given Rs.100 on admission. 
Meanwhile, the department is talking to a local organisation but appears to be waiting for it to get formally registered as an NGO, before a kitchen can be made functional. 

However, it seems that rules are being violated at the very outset. Gulbai Bheel brought her sick one-year-old daughter Leela from Madanpur village. She did not get any money upon arrival, nor was she told that she was entitled to Rs.35 a day as food allowance. Gulbai had not eaten all day, nor had any of the three other women who had arrived at the hospital the day before. The fathers who brought their children had not eaten either, and nobody seemed to know whether they were entitled to a food allowance. 

Sheopur might take a leaf out of neighbouring Shivpuri district's book. Shivpuri, which also has a large tribal population with a serious malnourishment problem, was the first district in the State to start implementing the Bal Shakti Yojana and has already got four Nutrition Rehabilitation Centres in place. 

The Collector, Dr. Manohar Agnani, told Frontline: "It has only been seven months and we cannot say that the effort is either complete or foolproof. Our capacity is 76 beds and by the most conservative estimate, there are about 3,137 severe cases in this district. We have catered to about 1,000 children already and are taking care to follow them up when they leave the hospital. We have surveys to monitor progress and we admit there are failures. For instance, despite our efforts, some of the Grade 4 children go back to their villages, and they cannot be brought down to grade 1 or 2; a few have even died. But slowly, we are building capacity and will have more centres in each block. The Gwalior Medical College is helping, UNICEF [United Nations Fund for Children] is helping and we get clothes or toys as donations for the children. We have also written to the State government recommending 70 recipes that can be tried at anganwadi centres, using ingredients that are available locally and are nutritious." 

The results of the eighth Bal Sanjivani campaign survey (2006) are disturbing. In Madhya Pradesh, 49.21 per cent of the children were found malnourished, 0.91 per cent seriously so. That is well within the limit of 1 per cent set to be reached by 2007, but the figures are much worse for districts with large tribal populations. In Sheopur, which has the worst record, 57.68 per cent of the children are malnourished, of whom 2.59 per cent are severe cases. 

Madhya Pradesh also has the dubious distinction of being number one on the list as far as infant (less than a year old) mortality rates are concerned. 
There are 79 deaths for every thousand live births. In effect, this means that at least one lakh children die each year in this State alone. Child mortality rates (for children between ages one and five) are even higher, at 137 for every thousand. While disease and infection are among the reasons, malnutrition is an equally important factor. 

Every year, reports of starvation deaths trickle in from different parts of the State. Three cases were reported from Chhatarpur in the past fortnight. Earlier, one child died in Piprani and at least four died in Gadla village. None of these villages was particularly remote. There is no way of knowing how many might have died in villages to which there are no proper roads and where there are no telecommunication facilities. 

At present, the State of Madhya Pradesh sets aside only Rs.150 crores for feeding children at anganwadi centres, at the rate of Rs.2 daily for every child. Going by the 2001 Census, Madhya Pradesh has at least 1.06 crore children under the age of six. At least Rs.600 crores will be required to feed them all one small meal a day. Surely the situation calls for a bigger budget for the State's underfed children.