India 2012

Shining, Unequal

Vikas Samvad
(A Human Development Resource Centre for
Research, Analysis and Action)

www.mediaforrights.org
vikassamvad@gmail.com
 Foundation of the thought

| Women and Children do not die because of diseases always.

| People are always not killed by weapons, arms, missiles, grenades

and ammunition.

| People are killed by policy negligence; indigenous families are killed

by forceful eviction and displacement.

| Women and children die because of lack of basic health facilities and
medicines.

| Humans do not die because of diseases always; they mostly die because
they are held in reserve empty stomach.

| They are not hungry alone, they are ravenous.

| They don't starve, because there is no food, their dead-bodies

are usually found surrounded by mounding food stocks. They did not
have a right to eat it;

| People do not die because of wars or epidemic alone. Policies have been
biggest killers always;

| They are exterminated by just deleting their names from the poverty line
list;

| And the growth of the country continues;

 Shining India with widening Inequality?
Agriculture and Food Security in Indias 2012 Economy

The Union Government has increased its Defence spending by some 18 percent and its budget
has been hiked from last years Rs.11,64,000 Crores2 to Rs. 1,93,407 Crores, this year. But in the
Annual Budget, the Central Government has made an allocation of Rs. 20,822 Crores for
agriculture, a mere tenth of the amount earmarked for Defence. Over the next 10 years, the
government intends to spend Rs. 4.9 Lakh3 Crores on defence and Rs. 50,00000 Crores on
infrastructure. Yet it cites serious funds constraints in making allocations for agriculture, food
security, nutrition and health. The total outlay for expenditure in the Central Governments
annual budget estimate is Rs. 14,90,925 Crores, which has been raised from Rs. 12,33,000
Crores in 2010-2011 budget estimates. This is also the time, which is leading us towards more
challenges for the federal structure of the country; when Centre is impatiently investing all its
energy and powers in making laws and policies for food, agriculture, and natural resources to
ensure a classified exploitation of them through the big corporations. These are the sectors,
where state and local bodies must have a larger role to play in decision making and
implementation; but an infringement exercise is on the full flow.
It is not difficult to see the kind of changes that have occurred in Indias economy over the past
64 years since independence. Agriculture has always been the mainstay of our economy and
social system yet the government has shown a marked tendency to ignore this sector. It had
anticipated a growth rate in excess of 8.4% last year, with agriculture growing at 4%. But its
hopes were belied and agricultural growth is not expected to exceed 2.5% in the current year.
Yet we see that the hospitality sector, transport, communications, financial services, insurance
and real estate trade have been clocking 9-to-11% growth.
The 11th Five Year Plan had pegged the agricultural growth rate at an average 4% per annum
but the actual achievement during the Plan period was 3.3% per annum. Every day 2,000
farmers turn their back on farming and every half an hour a desperate farmer commits suicide.
Agriculture is crucial to India both in terms of employment and food security. The country
claims to have achieved 7.94% growth over the last Five Year Plan period, yet our economist
Prime Minister has no compunction in pointing out that 6.5 Crore children are currently victims
of malnutrition, referring to this sad fact as a matter of national shame.
Why is there hunger and starvation in the country? The Union Finance minister says 25 Crore
tonnes of food grains will be produced this year, which is a new record and a five-fold increase
from 1951 when we produced 5 Crore tonnes. Truly, the government loves to juggle with the
statistics. How on earth can we expect a country currently witnessing stagnant agricultural

1
Rupee is the Indian currency and Rs. 50 is equal to US $ 1.
2
1 Crore = 10 Million
3
1 Lakh = 100 Thousand
growth to guarantee food security for its people? In 1961 the daily per capita food availability
was 399.74 gm. It raised to 468.5 gm at the time the reformist open market policies were
ushered in. Since then the figure has shown a steady decline - or stagnant growth - with the
daily per capita food availability in 2010-11 being 407 gm. After 50 years of growth we are back
where we were in 1961. What kind of growth is this?
It is not as if growth is not possible. Any sector the government focuses on and develops sees
strong growth. It designs its policies to foster this growth. Yet it does not lift a finger to develop
agriculture even as it continues to express the greatest concern for the sector. All we see is the
government shying away from taking the kind of basic steps necessary to solve the crisis
agriculture finds itself in today.
In 1950-51, agriculture contributed 53.1% of our Gross Domestic Product (GDP). This
percentage has fallen to 13.9% today. In direct contrast, the contribution of the services sector
has risen from 30.3% to 59% during the same period5.
Even in 2012, 56% of our population is dependent on agriculture for a livelihood. The
government would like to see this large segment of our population migrate to other productive
sectors. But there appears to be a hidden agenda behind this thrust. It favours the
commoditisation of agriculture not for the sake of creating livelihood source. Rather its from a
profit making perspective with large multinational companies and corporate houses acquiring
over thousands of hectares of land for agricultural production. Do we need to look any further
for the reasons behind farmer suicide taking place every half hour?
The government is also coming down hard on subsidies for agriculture. It feels giving
concessions in any sector is a fundamentally flawed policy because it does not create the right
conditions for an open market system to flourish. Companies battling it out in a highly
competitive open market cannot trade profitably in agriculture as long as the state continues to
dole out concessions to farmers. So, inevitably, we witness a constant whittling down of
agricultural subsidies. Presently Government of India allocates 2.5% of GDP for subsidies, which
has to be brought down to 2% in next 3 years and than 1.75% in the plan period. This reduction
will cause inflation, restriction in access to Health, Education services and will lead people
towards chronic hunger and deprivation. Farmers and Unorganized sector works are the new
colonies of the new and shining India.
This process of doing away with subsidies will be hastened in the 12th Five Year Plan (2012-16)
which is to be launched soon. In the very first budget of the 12th Plan period Union Finance
Minister Pranab Mukherjee has replaced the fertilizer subsidy given to farmers with cash
transfers. This means the government will give the farmers a fixed sum of money with which
they will have to purchase their fertilizer requirements from the open market. Prices in the
open market are determined by the fertilizer manufacturing companies. It is they who now
stand to benefit since they can recover their money from the farmers.

4 th
Economic Survey 2011-12 (presented on 15 March 2012)
5 th
Data in this paragraph obtained from Economic Survey 2011-12 (presented on 15 March 2012)
It is a double whammy for the farmers, who will now also have to pay more for the electricity
they utilize for their agricultural operations. As many as 18 state governments in the country
have taken massive loans to distribute electricity to rural areas. So an increase in electricity
tariffs is very much on the cards when the time comes to repay the loans. The farmers will bear
the brunt of these increases, the state governments justification being that the loans were
taken for their benefit in the first place.
The present subsidies on food, petroleum and fertilizers amount to 2.5% of our GDP. The
government envisages the subsidy burden being brought down to 2% over the next three years
for it to stay on course to achieve the Plan target of 1.75%. This implies progressive increases in
the prices of petrol, diesel and fertilizers in the coming years. At the same time, the
government is also preparing to withdraw from the public distribution system. It isnt rocket
science to foresee the consequences of these moves. Inflationary pressures will increase as
these products become more expensive, leading to an all-round rise in the cost of living.
The development of our agricultural system and the welfare of the farming community cannot
be ensured merely with promises of fertilisers or seeds. Nor will ad hoc financial support
packages put an end to farmer suicides. What is required is the formulation of a new
framework for the system. We need to take a totally new approach to issues like seed supply,
soil fertility, proper use of fertilizers and pesticides, irrigation, availability of electricity, and
product-oriented markets. Instead, the government is bent on formulating policies that are
antithetical to achieving these goals.

Food Security in India

Rural economy will get a fresh lease of life, if Government decides to base its food grains
production policies and promotes the cultivation of local coarse grains. This move will also
ensure greater food security in the rural countryside of the country.
In India, one of the consequences of the Green Revolution was that it brought in mono-cropping leading
to a drastic reduction of crop diversity of farm lands. This shift in agriculture focusing on a market-driven
economy where cash crops took precedent, had its toll; household needs for a range of cereals, pulses
and vegetables were not met from the farm but purchased from the market.
Prior to Green Revolution in the 1960s, there was cultivation of 300 varied varieties of cereals
but in its aftermath, the focus shifted to mono cropping, only wheat and rice. Earlier 16
varieties of pulses were cultivated but later on it was reduced to five. But there was no talk at
all of the 11 varieties of oilseeds in use. If India is to follow a path of development that helps it
to emerge from the clutches of hunger and starvation, the Governments National Food
Security Bill should foster diversity and encourage the cultivation of different varieties of
cereals and pulses. It requires courage to follow such a course because it means resisting the
pressure from the business class that trades in foodstuffs.
We are not advocating this path of agricultural production for the benefit of multinational
companies. That should be amply clear. The best bet would be for the government to buy the
total output and channel it into the local distribution system for consumption. Only after
adequate supplies for local consumption is ensured should ragi, kodo, kutki, jowar, makka and
other minor grains would be traded in the open market. If the government formulates policies
for storing these local grains at the block level to feed them into the public distribution system
at a decentralised level, its expenditure on transport and storage will be minimized. In such a
changed scenario, suicide will no longer appear the best option open to farmers since they
would now have access to a market that will not belie their hopes.
One thing is clear. If the government is serious about eradicating hunger and malnutrition, it
needs to make fundamental changes in its agricultural and food policies. As long as it continues
to follow its present chosen path the country will continue to witness ever-increasing levels of
deprivation and food insecurity.
According to the 2012 Economic Survey, India produced 24.48 Crore tonnes of food grains in
2011. Of this 6.1469 Crore tonnes (25.1% of the total production) were utilised for food grains-
linked programmes such as the public distribution system, mid-day meal programme and ICDS6.
Over the past two years we have been repeatedly hearing the logic (given by everyone from the
Union Agricultural Minister to corporate representatives) that it is not possible to implement a
universal National Food Security Act because that would require providing cheap foodgrains to
78% of our population (who do not get adequate nutrition and who do not have the buying
power) and we just dont produce enough foodgrains for the purpose. A related argument
pointing to the impracticability of such a move is that to implement such a programme the
government will have to take over the responsibility of buying all this food grain in the open
market.
But the truth is slightly different. If the government makes up its mind to free every citizen of
the country from the ravages of hunger and malnutrition, it will have to procure just 55% of the
total foodgrains required; the remaining 45% will still be available in the market.
This is not all. The economic survey points out that the daily per capita availability of pulses in
India fell to a mere 31.6 gm in 2010-11 from 69 gm in 1961. But is the government concerned
about this dismal situation? Apparently not, of we take a look at the statistics of irrigated
agriculture. We find that only 16% of the land under cultivation of pulses is irrigated. The figure
for oilseed crops is a bit better at 27.1%, but that doesnt mean people have better access to
adequate supplies of edible oil either. The astounding truth is that even today we import 50%
of our edible oil requirements from other countries!
The budget has given firm indications that cash transfers will be the order of things in lieu of
fertiliser subsidies and a similar system will be followed as an alternative to providing
subsidised rations through the public distribution system. The greatest impact of this system of
cash transfers will be on those farmers from whom the government currently procures 4 Crore
tonnes of food grains. Government procurement of foodgrains for the PDS will fall by 50% once
the people are given cash transfers and told that they will not get grain from the PDS but will
have to purchase their requirements from the supermarkets that have come into existence in
the retail space under the 51% FDI policy.

6 th
Data in this paragraph obtained from Economic Survey 2011-12 (presented on 15 March 2012)
The other crisis in the making is that when cash flows into the pockets of the poor, the
probability of the money not being spent on foodgrains but on other necessities is high. There is
also the fear that in a patriarchal society, where the male heads the family also has control over
wealth and money, the women will suffer the most because it is unlikely that they will be in a
position to avail of the benefits.
Governments weaknesses are reflected in the tenuous foundation of the National Food
Security Act that it seeks to implement. The Act will neither be able to eradicate hunger and
malnutrition nor assure proper utilisation of our resources, given the fact that the Government
continues to weave the same web of deceit about the poverty line when it is clear to one and
all that its BPL list will exclude 42 Crore people from the benefits under the Act.
Government has again reiterated that it will only distribute wheat, rice and limited quantities of
coarse grains. But the scientific evidence accedes to the fact that nutritional deficiency cannot
be corrected with cereals alone. It would also require additional supplies of edible oils and
pulses. But the proponents of the present economic system repeatedly point out that
Rs1,15,000 Crores will be spent on cereal distribution and ask why the taxpayers money should
be spent on such subsidies. They tend to forget that it is the policies and those who benefit
from them that are directly responsible for the masses of people becoming victims of poverty
and starvation.
In his budget speech the Union Finance minister made it clear that the Food Security Act is not
intended to ensure food security for all but only to the poor and the BPL sieve will continue to
be used to filter out those it does not consider to be poor from the list of potential
beneficiaries. He also gave no indication that provisions would be made for distributing pulses
and edible oils to BPL families. The implications are clear. Under the pressure of having to
achieve its target of a lower subsidy bill, the government has formulated a weak food security
act.
The expenditure on the Public Distribution System and subsidised grain is estimated at
Rs. 72,823 Crores for 2011-12. For 2012-13, the Union Finance Minister has allocated Rs. 75,000
Crores7. It would have been good if he could also have stated that the Act would protect the
interests of our farmers. If that is the way he really felt he would not have to spend sleepless
nights worrying about the subsidy burden.
The biggest challenge is that the Government is not looking at the agricultural sector holistically
but in a piecemeal manner and making patchwork plans to fulfil its obligations. It knows that an
integrated approach to agriculture would endanger its corporate-centred development policies.
This perspective is reflected in many ways. For one, it refuses to see agriculture as the fulcrum
on which the rural economy rotates. Instead, it has formulated a national agricultural
development plan that focuses on the production of select commercial food commodities,
making a provision of Rs. 6,755 Crores for 2010-11, Rs. 7, 860 Crores for 2011-12 and now
increasing it to Rs. 9,217 Crores for 2012-13.

7
Budget documents for the Year 2012-13 (India)
If you wish to cultivate coarse grains or minor millets, the plan will not extend any support to
you because it has already chosen 25,000 villages for the purpose. At the same time, it has
allocated Rs. 400 Crores in seven states for rice production and has now raised the allocation to
Rs. 1,000 Crores. But the allocation for pulses, whose production needs to be boosted, is a
mere Rs300 Crores for 60,000 villages, which works out to a paltry Rs. 50,000 per village! Nor is
any support extended to the production of edible oils like coconut, sesame and groundnut oil,
which are so integrally linked with the rural economy in many other ways as well. Instead, the
Government is encouraging imports of palm oil, which is endangering the livelihood of coconut
growers.
What is needed is the kind of holistic structural development in rural areas that would protect
all avenues of production, including agricultural activities.
Yet the Government has not come up with any scheme to guarantee farmers an income that
would keep them from the clutches of indebtedness. What it has done is make small patchwork
provisions for farming while paving the way for large corporate interests to enter the market.
Farmers cannot compete with multinationals. The least one could expect from the government
is that it ensures a level playing field for farmers so they can compete in the market.
The Union Finance minister has said that FDI in retail is now a given. Elaborating the
government stand, the Economic Survey states that the only way out of the present crisis
situation is to permit 100% FDI in wholesale and retail trade. But the reality is that such a policy
would destroy livelihoods, local systems of food security as well as the community based
structures that support the diversity in production. This is when large corporations will gain
total control over production and distribution.
There must be no confusion left in the discussion that ending chronic hunger is the ultimate
target of the Growth Story; the way Indian policy makers think; public expenditure on Food
Security and Hunger form the peoples perspective is not a wise investment. Although, it is
(sustained hunger) a great area for business so leave it unbolted for the private sector; exempt
them for paying any revenues to the state; divert food and agriculture subsidies from people to
corporates. And at the end why the revenue foregone must not be included in the Subsidy Bill
so that it is always clear how much resource go as subsidy for a particular sector?
On National Food Security Bill 2011

Amidst the cacophony around the Lokpal Bill, National Food Security Bill 2011 has been tabled
in the Loksabha. Whatever the Government of India has fleshed in the National Food Security
Bill is actually in pursuance with the constitutional obligations (section 47) and obligations
under various international conventions. More than that, it has been done in the larger context
of prevailing food and nutritional insecurity in one of the fastest growing economy of the world.
Still it has not gone the whole hog to hit the problem per se. Rather, it is just a beginning to
register the fact that hunger is a real cause of concern. The National Food Security Bill, in its
present form, is not adequately endowed with a vision to address the very structural causes of
Food and Nutritional Insecurity in India.
Three basic issues are at hand: 1. The Bill dwells on targeting vis--vis universalisation; re-
invoking the contentious BPL-APL battle-lines (Priority and Non-priority households). The
intended benefits will be given to the people based on these categories. It is a quite well-known
fact that the successive Governments have failed in identifying the poor, and as a result,
majority of our population continues to live with hunger in various forms. In such a grim
scenario, the Government should be talking about Universalisation, which is an integral part of
Fundamental Right to Life. 2. The Bill provides for a supply of 7 kg per month of subsidized food
grains per person in the priority households, whereas the monthly requirement of a person is
14 kg to fulfil the basic food requirement. 3. The proposed entitlements do not deal with the
problem of nutritional insecurity. In India, people have suffered undernourishment majorly due
to Protein and Fat deficiency. Hence to cope up with the problem, Government should have
added pulses (to compensate for protein) and edible oil (to replenish fat), as the preamble of
the Bill also mentions: the Supreme Court of India has recognized the right to food and
nutrition as integral to the right to life
But the most important is to answer the questions being raised by the Anti-NFSA sections of the
society as well as in the Government. Today, development is only understood in the narrow
terrain of economic growth and Indian policy makers seem to be haplessly infatuated by GDP
numbers and their growth thereby. But they have not stepped beyond their narrowly familiar
paradigm and taken a genuine interest in the general improvement in living standards and
enhancement of peoples well-being and freedom! How can Indian polity accept such a growth
trend wherein 70 percent of the total GDP is directly under the control of 8% of Indias elite?
Growth is important, because it helps create a conducive environment for the welfare &
betterment of the people. We cannot, however, accept a growth trajectory that curtails the
opportunities for common people, grabs common property & natural resources for short term
gains. While the India's economy has been growing at a pace of 6 to 9% in the last 12 years,
under-nutrition among the children has gone down by a trifling 1% in the 9-year interim of
1998-99 to 2006. Should we accept a mere token 0.1% decline in childhood hunger per year?
We also need to be honest in accepting the fact that under-fed can not contribute, even if
provided with opportunities because of lack of capabilities. We will have to build an
environment of empowerment with nutritional security, so that they become capable
nutritionally. Otherwise how one can expect that hungry would go to the industries, set up with
huge public resources and subsidies, and starts working as labour or engineer!
Growth story has a flip side as well. The present level of malnutrition results in 2 to 3% decline
in the GDP. It causes delay in education, triggers learning disabilities; it affects the overall
lifelong physical and cognitive development of children right from the conception stage. Every
year, we lose 1.3 million children, who do not celebrate their fifth birthday and die due to
under-nutrition, lack of care and unavailability / inaccessibility of basic health care. One of our
neighbouring countries weighs up its development with a Happiness Index. Now as the
developed world, who has enjoyed the highest level of capitalism, is being devastated by a
debilitating economic crisis and as the citizens of many countries are protesting against the
prevalent economic policies, India should also learn and have a re-think that whether the
peoples well-being should be its priority, or just creating a tiny island of opulence for a handful
of people.
I just ask one question - Do we know that we contribute towards 40% of world's maternal,
neonatal, infant and child deaths? We have world's half of the under-nourished kids? We have
54% women suffering from anaemia? Dont we want to remove this blot from our face? I dont
think we would like to, should or can continue to do injustice with our people. We will have to
end this national variety of colonialism, where the corporate world rules over our farmers and
labourers, traders indulge in the business of education and health services, and keep people
deprived of the very basic services in the name of Growth. Of course, faster growth generates
resources but these resources must be used for the well-being of the people at large. This
surplus should not be furthered for subsidising the corporate. The proposed bill again shows
faith in targeting so-called poor and non-poor (in the name of priority and general
households); let us remind ourselves that we have been revoltingly unsuccessful in identifying
poor and continue to implement our most crucial food-social entitlement programs based on
exclusionary poverty line conspiracy; without any hesitation.
I take my argument further by citing the fact that over 1.6 million hectare land has been
transferred for the real-estate and industrial development purposes, natural forest cover is
rapidly declining, water resources are drying up and getting contaminated, agricultural
production cost has gone up by 189 percent in the last 20 years, but our small and marginal
farmers never found the policy interventions on their side in order to have any kind of
structural protection against the marauders of the open market. Here, we are talking about a
growth scenario, wherein India was in need to create employment opportunities for its 45
millions but it could provide employment to only 2.1 million people. All these shortfalls are the
basic cause of hunger. Prof. Arjun Sengupta in his report on unorganised sector mentioned that
77% of the population survives by spending Rs. 20 a day; while on the other hand, NNMB
figures show that 76.8% population do not receive prescribed norms of nutrition! We need
STRONG POLITICAL COMMITMENT; otherwise Growth in Hunger will be our leitmotif.
In these two decades of our new economic policy (NEP), one thing has come out very clearly
that 90% of the population could not get any benefit out of, or due to it. They somehow survive
on the fringes of our political economy.
Measures to end hunger should not be delayed any more by saying that we are facing market
crash? Or we are in recession. We must know that, economy may also be collapsing of
surmounting hunger wherein people are no more in a position to contribute in the stabilising
internal economy.
Our country is being run by the economists, but they sound so useless and illiterate OR just
trying to be illiterate! Have you heard ever any economist (from planning commission, PMO or
RBI) has ever said publically that GoI is doling out almost Rs. 6.22 Lakh Crores as tax-revenue
subsidy in the financial year 2011-12, which is registered as Taxes Foregone and it counts for
65% of Government's total revenue. Last year this figure was Rs 5.36 Lakh Crores. A total of Rs
23 Lakh Crores in 6 years has been smashed into the corporate worlds billionaire coffers. No
one has asked why? In contrast, the agriculture subsidy has been converted into direct loans to
farmers, petrol has been handed over to market, public expenditure on basic services like
health, and education and water are reducing. Who is toying with the India's balance sheet?
Why there are so many hue and cries on NFSA expenditure?
Already we are spending Rs. 67,310 Crores as food subsidy, and there will be only a tiny
increase of another Rs. 30,000 Crores, just a trifle 4% of the taxes which being usurped by the
corporate-economists-government nexus. Simply feel the positive impact of this humane
expenditure. It will preserve human values of India, it will feed those 77 Crore humans sleeping
hungry at present. Government of India will only be giving a subsidy of Rs. 1188 per person per
year or Rs 3.25 a day. BUT we have ministers, economists, policy makers and consultants', who
just do not want the State to do so! Even our prime minister also is not very happy with the
idea.
Actually, this is an outcome of welfare politics, which has become very imperative in last one
decade or so. We have been running Integrated Child Development Services and having a plan
to spend Rs 80000 Crores in next five years; Mid Day Meal scheme is already in place. We have
a 17 Crore population of children under-6, 45% of them are under-nourished but we barely
spend Rs. 1.62 per child per day on their growth and nutrition. The matter of fact is that private
food market will lose some profit due to this legislation and there will be a control over
inflation; which is just not acceptable to the market. Just take the example of second and third
quarter of 2011-12, while the growth rate came down to 6.8%, food inflation also declined from
16% to 1.7%. So, the indications are getting clearer.
There is an argument that it is better for the government to focus on productivity enhancement
rather than focusing on dolling out subsidies at the expense of tax-payers! But these two things
are not mutually exclusive; they are complementary to each other. Let us understand one thing;
India is not a food deficit country, we produce surplus food grains, we throw it in the sea, we
export it, but due to various reasons, it does not reach to a large number of our hungry people.
If this continues, the argument of productivity will not hold any water. Yes, this is a fact that we
still have one of the lowest per hectare production, but this is also the time to think on the
adverse impact of technologies on agriculture.
A part of this discussion is linked to Public procurement and MSP. If government stops
subsidising agriculture, profit makers will benefit and consumers will have to pay high prices.
Just take the example of pulses. We pay Rs. 36 per kg as MSP to the farmer for Tuar dal, but the
market price was Rs. 110 some time ago. There is an urgent requirement to ensure maximum
public procurement, which can only be done and applied through Public Distribution System. If
you stop procuring food from the farmer, farmer will suffer till he/she dies. Second aspect deals
with the policy perspective. For last 20 years, the per capita food production in India is stagnant
around 460 grams per person per day; pulses are the key source of protein, but the availability
has gone down from 70 grams per day in 1960s to 42 grams in recent times. We adopted new
technologies: hybrid seeds, chemical fertilisers and pesticides in order to increase agriculture
production. Punjab sacrificed its community techniques and blindly used high quantity of
chemicals, which has finally now resulted in a heavy decline in soil fertility there. Overall, the
present draft of NFSA 2011 does not provide any revolutionary thing; it is just modest. We have
to think, and decide - who our priority is.
 The Conspiracy of Corporatisation of Indias
Agriculture
We want to create a model where corporate market will address the problems of agriculture by
taking it over! During the initial four days of April, 2011, when the entire nation was reeling
under the intoxication of the semi-finals and finals of the Cricket World Cup, when the prime
minister, president, ministers and bureaucrats were gripped in its fever and cricket was
indiscriminately splashed across the media (which can now be considered blind and anti-
people), the Government of India issued Circular 1 of 2011 relating to its Consolidated Foreign
Direct Investment Policy, opening up the floodgates for 100% FDI in the agricultural sector.
Usually our government takes such decision when our society and media is busy with some kind
of mania.

Any foreign company can now exercise direct control over the production, research and
development of seeds, plants, flowers, vegetables, tea, mushrooms and other agro-products.
Animal husbandry and pisciculture have also been included in its purview. The government will
now provide exemptions in import-export taxes and duties to profit making companies,
allowing them to play around with whatever is left of Indias agricultural resources (its land,
seeds, agricultural techniques and produce, horticulture, floriculture, pisciculture, animal
husbandry, etc).

Even without this policy of 100% FDI, 225 thousand farmers have already committed suicide.
Now this number will increase unimaginably. The suicide rate will now climb because local
producers of coconuts, tea, mushroom, fruits, flowers as well as those in dairying and fish
production will now have to compete with large corporations with ample economic resources
who are being protected by government policy and international financial institutions.

The multidimensional corporate threat

In India, there has always been a close relationship between farmers and their produce, with
the network of wholesale Krishi Upaj Mandis (state controlled agricultural produce markets)
serving their needs for the past four decades. Over the past 10 years companies like ITC and
Cargill have set up their own parallel network for purchasing agricultural produce directly from
these producers. Economists like Montek Singh Ahluwalia feel this gives farmers a better
system of services that fetches them better prices. He is among those who think that it is better
to set up a parallel system if the government system does not work rather than improve it.

On April 4, a farmer died in a krishi upaj mandi in Raisen district of Madhya Pradesh. He had
been waiting eight days to sell his produce but couldnt do so because he did not have the
requisite gunny bags. The tension proved too much for him to bear. In majority of mandis, long
queues of farmers waiting to sell their produce can be seen all across. In Madhya Pradesh, a
crisis of packing bags (Baardaana) is created every year. State allocates 6.7 million bags for
packing agriculture products in mandis, but only 3 million are used and this results in long
waiting lines of farmers. This increases the cost of production, as transportation expense goes
up every day.

The situation in mandis is far from satisfactory nowadays. It has become a very important
uncomfortable place for farmers. Farmers are often not paid for up to 8 to 10 days after selling
their produce. Thats why they are now looking to other avenues. The question is why isnt it
possible to set up an effective payment system in mandis? The answer may be found in the way
they function. For example, mandis demand six types of documents from farmers who come to
sell their produce. Is this necessary? Should the system be so complicated that it drives farmers
to desperation? On 7th April 2011, because of untimely rains, 1000 metric tons of grains got
wasted as it was lying in open. The point is why all mandis have no proper shelter facilities.

It is such factors that are weakening the mandi system, creating an environment in which
private companies flourish. Today, three companies have captured 30% of the market even as
the government is slowly moving towards dismantling the mandi system.

Eagle eyes on systems

Companies like ITC and Cargill treat farmers with a modicum of respect today because they
know the mandi system is still available as an alternative. Once the system degenerates, they
will begin to bare their fangs, showing their true colours.

Our analysis tells us that large corporations have infiltrated and taken control of every facet of
agriculture (resources, production, marketing, supply, even consumer behaviour and
consumption patterns). Till now they were involved in producing canned goods and packaged
food but the situation is changing and they are now taking control of the production of raw
materials. They produce groundnuts, tomatos, potatos, chilli, rice, fruits etc. As a result, farmers
can no longer decide what they want to grow and it is becoming increasingly unclear what kind
of protection the government policies will provide for them.

This is not the end. They have also almost controlled 37% of sypply and marketing chains, which
gives them a authority to decide who will sell and what! The corporate infiltration covers the
entire value chain right down to the consumers. Retail giants like Carrefour, Wal Mart, Reliance,
Bharti Enterprises, Future Value Retail and Spot Hypermarkets have formulated plans to add
another 510 supermarkets and malls to their already extensive retail network.
This is, indeed, the irony of the situation today. One cannot get a few hundred square feet of
land in Delhi, Bengaluru, Kolkata, Mumbai and 2 other cities to build a house but according to a
Knight Frank India report India Organises Retail Market 2010, these cities will make available
55 million sq ft of land between 2010 and 2012 for the retail trade. Where will this land come
from? Obviously by displacing slum and pavement dwellers!

The Political Economy of Organic Food

One new development in the agricultural sector is the growing interest in organic farming as
the chemicalization of agriculture products moves apace. In India, organic produce has
traditionally reached people directly from the farms, coming into the markets with labels like
local tomatoes or local bottle gourd. However, this is no longer the reality.

As the demand from consumers for unadulterated and chemical-free food gains momentum,
giant global multinational corporations are taking control of organic farming and the trade in
organic foodstuffs. The argument they offer is that it doesnt matter who owns the proprietary
right to this market, given the growing dangers of large-scale chemical use in agriculture.

These mammoth, financially strong corporations know that the market for organic foods is
growing rapidly. According to the Organic Trade Association, it had already grown to US$ 28.4
billion in 2009. Thats why these corporations took over as many as 363 small local production
units across the world from 1997 to 2007. For example, Coco Cola has taken over Honest Tea.

This underlines the growing dangers of economic colonialism in food trade as the market for
organic foodstuffs continues to expand.

The danger is magnified because it is no longer possible to trust these corporations considering
that it is they who, to a large extent, are responsible for the presence of dangerous levels of
pesticides in cold drinks, the use of unacceptable chemicals in canned foods and the spraying of
endosulphan in agricultural fields, no monitoring of dangerous chemicals usage in agriculture
field etc. The world can no longer believe these companies that are poisoning our grain and
food in their willingness to go to any length to earn a profit.

Thats why, as a matter of policy, most of them have continued to trade in the local brand
names of the companies they take over to ensure that their tainted reputations do not impact
on their new trade in the market. Muir Glen and Cascadian Farm are being run under the name
of Small Planet Foods, which is in reality a General Mills company. But people still remain
skeptical about whether such companies will actually make organic food available to them.

We firmly believe that it is essential to stop the entry of multinational companies into this
sector as farmers increasingly move from chemical-based farming to organic farming as a long-
term solution. Farmers are switching over to organic farming and it is gaining momentum, as
seen from the example of Andhra Pradesh, where farmers in 23 districts have switched to
organic farming but there is no policy to protect them from corporate giants.

However, till now, there is no policy formulated to protect these farmers from the predations
of monster corporations. In such a scenario, the most important thing we need to remember is
to ensure that the production of foodgrains remains decentralised, people-oriented and
transparent, especially since 67% of Indias population depends on agriculture. It is a matter of
survival of moral policies and attitude in agriculture sector.

Whats required today is to develop a complete organic farming ecosystem that produces a
diverse range of food-grains, conserves livestock resources and incorporates traditional
practices, nutrients and organic insecticides.

It is doubtful that multinational companies would be interested in developing such an

ecosystem. Instead, there is every fear that they will use genetically modified seeds and
continue using chemicals in some form or other. They only believe in manipulations and
corruption in practice and in policies. These are the new fears facing organic farming in todays
world.

Agriculture for Money, not for Food Justice

Now foods corporates are looking towards ensuring their monopoly over all section of
agriculture system. The food production system is important in the administration of food
security. As important is the market system. In India, 29 million people are engaged in food and
related material trade. They do not trade for profit alone but play a central role in ensuring
access, which is a vital element in the concept of food security.

However, predominantly food-trading companies are now seeking to establish their collective
authority over this market to get control over accesses. They include Wal Mart, Reliance, Bharti
Enterprises, Glaxo SmithKline Consumer Healthcare, Nestle, Cavin Care, Field Fresh Foods, Del
Monte, Buhler India, PepsiCo and Coca Cola. According to a new report from market analyst
RNCOS, Indias food market is growing 7.5% annually and will be worth US$330 billion in 2013.

The Agricultural and Processed Food Products Export Import Development Authority (APEDA)
estimates that Indias exports of agricultural products could touch US$22 billion by 2014. The
countrys exports of flowers, fruits, vegetables, animal products, processed foods and fine
grains were worth US$7,347.07 million in 2009-10.

The Indian government is spending Rs 1.5 lakh crore to usher in a second green revolution
through food processing. According to Indias Minister for Food Processing Industries
SubodhKant Sahay, the government will invest US$21.9 billion in this sector over the next five
years. As far as foreign direct investment is concerned, it is expected to rise to US$264.4
million.

These astronomical figures are like a time bomb, with the potential to wreak devastation.

Market analysts predict that the share of the food processing sector will in all probability rise
from the current 6% to 20%, taking Indias share in the global food processing market from
1.5% to 3%.

Initially big food companies took control over research and development of seeds and
pesticides. In fact they were successful enough in grabbing Indias best agriculture universities
and institutions; now they directly farm lands in hundreds of thousand hectares and producing
what they need for processing and packaging; they have marketing and supply chain, that
ensures their access directly to consumers, so how they control the consumer science as well.
Now look at their reach in the Indias government system. The 18 officers of big companies like
Coca-Cola, PepsiCo., Nestle, ITC, Hindustan Unilever, Marrico, Britania, etc have been appointed
in the scientist panel of Food Security Standards Authority of India. These panes are
empowered to suggest policies and amendments in system relating to Functional Food and
Nutrition Products, Sampling and Analysis, Flavoring, Pesticides and Antibiotic components in
Food, Labeling, Advertisements and Claims etc. You may like to imagine what kind of systems
and regulations would be framed and enacted and who will benefit from them!

Farmers agriculture Vs Corporate agriculture

However, the focus of this new green revolution is not the farmer and his field but
multinational corporations, to whom the government is progressively handing over control of
natural resources and the production system. The government wants to create a suitable
environment for these companies and financial institutions through its massive investment and
other concessions.

Just eight companies (Cavin Care, Nestle, Glaxo SmithKline, Yum! Restaurants India, Feel Fresh
Foods, Buhler India, PepsiCo and Coca Cola) will be investing US$1,200 million in the food
production industry over the next two years. In addition to other exemptions, they will enjoy
100% exemption from tax on profits for the first five years and 25% exemption for the next five
years. Excise duty will be reduced by 50%. In fact, the budget decided these benefits for them
even as all concessions and subsidies to farmers were withdrawn.

Indias Planning Commission and economic advisors have been playing the role of agents of
these multinational companies, deciding that the country will industrialise its agriculture
through their intervention within 10 years. Thats why it permitted them and other companies
to purchase foodgrains directly from farmers in 2005, as a result of which the Indian
government ended up importing 5.3 million tonnes of foodgrains first time in last 10 years from
Australia, Canada and Ukraine at twice the price to meet the countrys needs.

Over the past four years, prices of foodgrains have risen 70% to 120% in the open market but
the government has raised the minimum support price for farmers by only 20% during this
period. It has failed to formulate any policy for controlling prices despite knowing that it is the
agents and traders who are cornering the benefits of rising prices. Instead, it lowered the
poverty line so it can trim the public distribution system, thereby lowering the quantity of
foodgrains it needs to buy in the open market.

This move gave companies the licence to purchase foodgrains from farmers at arbitrary prices.
These foodgrains are being exported or used for food processing. The priority is obvious - to
shift wheat from traditional usage for making chapattis to producing bread, noodles, biscuits
and canned foods.

In addition, approximately 10 lakh hectares of the most fertile land have been diverted to
cultivation of flowers and fruits for juice extraction, pleasure drinks and liquor production.

In Madhya Pradesh, three companies have unobtrusively entered into contract farming
agreements for potato cultivation to manufacture chips and tomato and green chili cultivation
for sauce and chutney production. This has led to a sharp decline in diversity of farming. In
Jhabua, a tribal district in MP, farmers have been enticed into such cultivation to the extent
where they are using 600 to 800kg of chemical nutrients for every acre of tomato cultivated,
completely destroying the fertility of their fields.

Under the policy of whittling down subsidies, the subsidies given for urea and DAP have been
discontinued. Diesel prices are also escalating while electricity tariffs have risen 190% over the
past five years. As a result, production costs of wheat have risen to Rs 1,650 per quintal while
the minimum support price remains pegged at Rs1,120 per quintal by the Indian government in
2011. For pulses, the support price is Rs32 per kg when the cost of pulses in the market has
risen to Rs60 to Rs90 per kg.

Which makes one wonder whether the government isnt the prime cause of farmer suicides?

In the decade of the 1990s when the policies of economic liberalization were initiated, the farm
sector availed of government subsidies to the tune of Rs220,000 Crores. Over the past 20 years
subsidies have been progressively scaled down, totalling less than Rs100, 000 Crores in 2011,
even as the government made provisions for giving loans totaling Rs375,000 Crores during the
year.
Leave alone its reluctance to subsidies the farm sector, the government in its wisdom isnt
prepared to accept that it is equally important to give subsidies to consumers. This would
encourage farmers to intensify farming, reduce their production costs and make agricultural
produce available to consumers at reasonable prices to fulfill their basic needs. We can see the
consequences of not doing so increasing production costs, increase in farmer indebtedness
and uncontrolled price increases. Farmers are committing suicide and consumers are victims of
starvation.

The governments approach is reflected in the statements put out by its ministers. Minister for
Commerce Kamal Nath said the shortage of foodgrains was the result of Indian people eating
more, the Minister for Agriculture Sharad Pawar (who is more interested in cricket) said it was
not his responsibility to bring down food inflation, Minister for Finance Pranab Mukherji said it
is not in our hands to bring down prices, and Prime Minister Manmohan Singh said the
Supreme Court should refrain from telling the government to distribute million of tonnes of
foodgrains rotting in government godowns among the poor because this is a policy issue (in
other words this would cause a loss to companies trading in foodgrains and the government
does not want this to happen).

Were they all trying to collectively deny the direct link between government policy, farmer
suicides and 76% of the people living in starvation conditions?

The corporate in retails;

Small retailers are also affected, their livelihoods jeopardized in these markets where almost
everything is now being made available in canned form of so-called high quality. This system
ensures that a powerful group now decides what consumers should eat and drink. Both farmers
and consumers are helpless in the face of this planned trade conspiracy. Its impact on farmers is
becoming all too evident, which is why 48% of farmers say they will leave farming if an
alternative presents itself because not only are they not earning a decent living now but the
possibility of doing so in future also seems remote. And the government is beginning to look
like their enemy in this entire process.

The politics of GDP;

These days our government is totally caught up in singing just one tune - of 8%, 9% and 10%
growth in gross domestic product (GDP). It finds pleasure in singing this tune because achieving
this growth rate is not a difficult task. But the problem is that the process is proving dangerous
as well.
The easy part of the equation is that whatever is bought or sold involves an exchange of value,
which puts money into the government treasury and benefits the people, leading to their
progress, or so the government says. What doesnt bring in money is useless for GDP.

Lets examine the proposition, as seen from the government perspective, a little more
explicitly. Forest, land, water, mineral products, mountains are all our resources. As long as
forests are left untouched GDP does not grow. When the government or a company fells the
forests, wealth accumulates. When water bubbles in brooks it has no value for the
government. But when a law limiting its use by people is passed and when control is given to a
company in exchange for a hefty price then GDP grows, even if the woes of people increase in
the exchange. When people are healthy, the development visualized by Montek and
Manmohan Singh doesnt take place, but when people fall ill, GDP grows.

If this is the kind of development they desire and work towards achieving, it means the forests
cannot be saved, nor the rivers or mountains, nor the mineral resources and land, nor the
health of the people.

Over the past 10 years the government has sold 10 lakh hectares of land. It has also sold a big
chunk of its ownership in the companies it owns meaning the public sector. The railways have
sold their lands, trees and minerals, which were the traditional wealth of forest communities.
They have given permission to mine coal, bauxite, iron, stone and marble, leading to lakhs of
acres of land being rendered useless for years to come. In the process, diseases like
tuberculosis and silicosis flourish, claiming thousands of lives.

Its on the back of such exchanges that we have been able to achieve 9% growth in our GDP.

The obvious downside of this growth rate is its negative impact on farmers and farming,
although the government refuses to acknowledge the existence of any problem in the sector.
Instead, it says we can target 6% growth in agriculture by displacing people from their villages
and land and opening the doors to large corporations who can contribute better to achieving
this growth rate. The irony is that the government in its wisdom believes this move will improve
the condition of farmers.

Agriculture will continue to experience the damaging impact of policy formulations and
planning for a long time to come. And so will the people.

In closing, pause awhile to cast a glance at the following information:

1. Chennai-based Cavin Care is investing US$109.50 million for cold drinks and salted
snacks production.
2. Nestle is investing US$50.49 million for a food products R&D facility in Manesar.
 3. Glaxo SmithKline is investing US$64.87 million on a milk products unit. This is the
company that produces Horlicks.
4. Yum! Restaurants India (which runs the Pizza Hut, KFC and Taco Bell restaurant chain
franchises) is investing US$100 million to open 1,000 restaurants by 2015.
5. Del Monte and Bharti Enterprises are collaborating with Field Fresh Foods to invest
US$25.93 million for an R&D facility in Hosur, Tamil Nadu.
6. Farm implements company Buhler India is setting up a production unit at a cost of
US$22.55 million with an expected turnover of US$225.49 million in 2014. Where and
from whom does the company hope to achieve such huge profits?
7. PepsiCo will be investing US$500 million over the next two years for its F&B trade.
8. Coca Cola will set up a bottling plant in Karnataka with a total capital outlay of
US$120.75 million.

These are just eight examples which will see a total investment of US$971.54 million (Rs 45720
Crores) over the next two years. This investment will cause even further distress and damage to
farmers, small retailers and the village economy.

And what does the government plan to do?

It will provide an impetus to contract farming to help these companies, having already
announced that food processing is a tax-free sector. It also plans to set up 30 large food
processing parks - which are basically special food zones like the special economic zones (SEZs).
Companies investing in the food processing sector will enjoy 100% tax exemption for the first
five years and 25% exemption for the next five years. The excise duty on canned goods has
been lowered from 16% to 8%.

Ernst & Young says in its report Flavours of Incredible India that the food market in India will
be worth an estimated US$181 billion by 2015, growing to US$318 billion by 2020.

It should also be noted that over the past 15 years, 13,000 small units manufacturing salted
snacks and ready-to-eat foods in cities and villages have downed their shutters. Policy of
corporatisation means policy of sustaining hunger and sacrificing self-reliance.
 Shining India with widening Inequality?
Public Health in Indias 2012 Economy

Indias Health - The growth dreams of an ailing society

I would like to begin my note by asking a set of questions Has Indias enigmatic and daunting
growth in GDP in any sense contributed in reducing socio-economic disparities? Ok, leave it!
Even has it been able to maintain the same level of disparities existed in 1970s in terms of
Health indicators or it has exacerbated the situation and caused increase in disparities? Just
think on any of these crucial determinants of Health and keep any vulnerable section of the
society in your imagination - Safe drinking water, clean environment, Sanitation and Hygiene,
Primary Health Care with quality, Corruption, Access to Food and Nutrition!! You have
increased number of hospitals but a large section of the society has no meaning of being them
on this earth.
Ideas are diminished these days and numbers are seen as useless; economics has gained more
importance but our countrys economists have lost their credibility in totality. But when you
combine ideas with statistics you come closer to the truth. Neo-capitalists convey their ideas
through statistics to influence the state to formulate policies that sustains capitalism and
nourish its adherents.
Capitalism is an ideology, a philosophy. Stated simply, it says if everything is in the control of
the state, people will have no alternative. If the state manages hospitals, people would have no
choice but to avail of these services. But if the state privatizes healthcare, using its policies and
economic resources to support and develop the private sector, then people will have
alternatives to choose from in the open market.
The same logic applies to schools. If the government runs schools there will be no scope for
innovation in the system and people will have no alternative other than to go to state-run
schools. The argument is simple. The government says if you want free education come to our
schools. But if you want to go elsewhere you can take the risk, but you must pay.
The government also supplies cheap food grains to a targeted class through its public
distribution system. But the market wants the government to put an end to this system and
give people cash transfers instead so they can have the alternative of buying grain of their
choice from the open market.
Neo-capitalism says the guiding principle of the economic system should be to let people have
the freedom to opt for the alternative of their choice. But its hidden agenda is clear to control
power it is necessary to control capital and to control capital it is necessary to limit the role of
the state. Its strategy is to create a doubt in peoples minds about the intentions of the state.
They should be given the feeling that state-run services can never guarantee quality and
innovation. These can only be had in the open market.
The new economic order has spared no effort to diminish the importance of the Constitutional
framework of welfare state by promoting private sector in processes relating to all basic needs
of human life Water, Health, Nutrition and Education. Nowhere does the class of people who
promise to make our lives better through the medium of the open market say they will set a
limit to their personal profit. Nor do they say they will be accountable to the Constitution. They
also never say the open market will adopt a welfare-oriented and rights-based approach to the
needs of the deprived and needy. All they want is control over resources and capital.
If people elect their representatives on the promise of getting grain at Rs. 1-2 per kg, or some
meters of paved road laid to their village, or a school for their village, it just goes to show that
even today the people continue to face a serious paucity of even the most basic services, which
they have anyway been deprived of for so long.
People have only a vague idea of the economic and political policies of our government. When
they cast their vote during elections, they have no basis for deciding which government to
elect. Their concerns are limited to getting basic services - medical treatment, medicines,
drinking water, sanitation, and being paid for their labour. This is where the state keeps them
trapped while it joins hands with corporate interests to trade in the exploitation of resources
and possibilities.
Our GDP is rising. But the question we need to answer is how is it rising? The answer lies in
medicines and medical treatments getting costlier, the increase in the number of cancer
victims, the razing of our forests for the sale of timber, drying up of our rivers, environmental
pollution, and so on. The greater the exploitation the higher is the growth rate! This is the
simple and clear-cut outcome of the countrys unequal and iniquitous political dispensation.
The thrust of the state is to maintain the status quo of inequality, prevent people from talking
about the systemic causes of their poverty, deprivation and want, stop them from opposing this
exploitation, and trap them permanently in a colony of neo capitalism.
Healthcare is not a minor issue. It is a crucial indicator of a respectable and honourable life.
Thats why it should never be seen only in the limited context of medicines and hospital
services. The Alma Ata Declaration of 1978 defines health as a state of complete physical,
mental and social well being and not merely the absence of disease or infirmity and its Health
for All goal envisages a level of health that will permit them (people) to lead a socially and
economically productive life. That implies developing a social environment wherein people
remain healthy and developing a system wherein health services are within easy reach of those
who fall ill. Instead, the development policies we have adopted view illness as an opportunity
for trade to bolster the GDP.
According to the 2011 census, India has 24.90 Crore households. If we talk in economic terms
about a just society can we not take an alternative view of the US $ 194.6 Billion of capital in
the possession of the countrys 48 billionaires not as their personal wealth but the wealth of
the nation?
Lets take this line of thinking a step further. According to the Global Wealth Report (2011)
India has 1,90,000 millionaires8 with a combined wealth of Rs. 86,50,000 Crores. This is more
than the countrys 2011-12 GDP. When you are told the country is progressing and you should
be happy, how would you feel knowing this truth? We should be clear in our minds that the
economic development policies that we have adopted, which maintain this social and economic
inequity, can never help create a better society. Whos growth is this actually?
The Indian government always keeps track of the conditions in which the population is living. In
February 2012, the governments National Statistical Organisation (National Sample Survey
Organisation) released a report on the household consumption of various goods and services
(Report No541-66/1.0/3). According to this report, the total consumption of a person living in
rural India amounts to Rs. 1,053.64 per month or around Rs. 35 per day. Of this, Rs. 600.36
(57%) is spent on food. In urban India, the figure is Rs. 1,984.46 per month or Rs. 66.14 per day,
of which Rs. 880.83 (44.38%) is spent on food. Filling ones stomach is still the most important
and most expensive task for people in our rapidly progressing country.
Education and communication are included in the development index on the basis of some
fixed criteria. The report states that the per capita monthly expenditure on books and
periodicals is Rs. 5.87 in rural India and Rs. 14.50 in urban India. Whatever be the priorities the
state defines for itself, the people know what their true priorities are. The state is not
interested in universalizing (with quality) the education and health systems; hence the biggest
chunk of the consumption expenditure after food is spent on these two basic services. The per
capita monthly expenditure on education and other fees is Rs. 21.48 (2.038%) in villages and Rs.
106.81 (5.38%) in cities.
For health services, the expenditure on medicines alone is Rs. 40.59 (3.58%) in villages and Rs.
62.05 (3.12%) in cities. Now witness the range of inequality the expenditure on medicines is
Rs. 125.63 in Kerala, Rs. 108.49 in Goa and Rs. 110.71 in Pondicherry while it is Rs. 33.98 in
Sikkim and Jharkhand, Rs. 29.25 in Assam and Rs. 40.98 in Bihar. This picture leaves no room for
doubt that the states priorities are to formulate policies that help establish an open market in
the food, education and health sectors. Indias Constitution unequivocally states that the
peoples right to life is a fundamental right. We need to remember this whenever we see the
distressing social and economic plight of the people. This fundamental right to life includes the
right to food, education and health, a fact that has been repeatedly stated by the Supreme
Court and also clearly enunciated by our Parliament.
The Lancet magazine publishes a series of papers on Health issues in India in early 2011. In one
of the article it says India has one of the most fragmented and commercialized health care
system in the world, where world class care is greatly outweighed by unregulated poor-quality
health services. Because public spending on health has remained low, private out of pocket
expenditure on health are among the highest in the world. Health care, far from helping people
rise out of poverty, has become an important cause of household impoverishment and debt. In
one of the paper published in the same series The Lancet mentions The average health
indicators, though showing improvements in recent decades, hid vast regional and social
8
Global Wealth Report 2011
disparities, Although some privileged individuals enjoys excellent health outcomes, others
experience the worst imaginable conditions. Health disparities are being exacerbated by
unequal economic growth, growing commercialization of healthcare and poor regulation of
costs and quality of care. As citizen of India, we have witnessed these injustices not only
professionally, but through our experiences of sickness in our families.
The problem is that the government is not in consonance with this line of thinking. It knows
that any commitment on its part to define these basic requirements for life and survival as a
fundamental right would create a climate in which a free market can never grow and develop.
One should have no illusions on this score. The moment the government is legally and
constitutionally bound to provide these services, the economic health and profits of the
corporate sector will be seriously affected.
Just observe the contradiction. Over the past 20 years, the private healthcare sector has grown
thousand-fold but the government has taken no steps to set up an institutionalized mechanism
to control or check prices in the sector. Instead, it provides free land or land at throwaway
prices to institutions seeking to build private hospitals and also dishes out liberal tax benefits,
the only condition being that 25% of the curative facilities set up by the hospital should be
reserved for providing free medical care to the poor. But most private hospitals blankly refuse
to honour this commitment once they receive this government largesse.
This only goes to show that privatization of basic services robs people of their fundamental
rights. This kind of blatant governance deficit that confronts us at every twist and turn today
closes the door on the poor and deprived classes, leaving them with no hope of ever accessing
these basic services.
Take the example of the governments flagship sanitation programme to build water-less
toilets. A brick-walled closet with a tin roof is constructed but the government then gives no
guarantee that water will be available for its use simply because daily requirements like water
are being privatized. So the only option open to the people is to use the railway tracks, turning
the Indian Railway network that transports 130 Crore people annually into the countrys biggest
open toilet chain!
The policy defining guidelines in our Constitution hold the state responsible for formulating and
implementing policies to improve the nutritional status and lives of the people. However, the
true face of the government is clearly seen in the latest Census (2011) figures released in March
2012. These figures bring out the discriminatory approach to development the government has
adopted, which blatantly ignores more than half the Indian population.
The reality is that 53% of the population has no access to safe drinking water, 50% defecate in
the open because toilets are lacking, 62% use wood fuel for cooking, only 29% have access to
LPG, 20% are homeless, 37% live in one-roomed tenements, and 49% live in habitations without
proper sanitation.
India may be creating waves in the world of information technology and communications but
only 3% of its people have access to the internet and computers!
The 2012-13 Budget cannot be seen as a routine budget because it is the first budget of the 12th
Five Year Plan (2012-13 to 2016-17). It shows that reformist policies continue to catalyze
economic growth. That much is clear. But this growth is benefiting only a very small and select
class of people. Let us take a closer look. It has an estimated expenditure of Rs. 14,90,925
Crores of which Rs. 30,702 Crores has been allocated for healthcare. This is considered to be
20% higher than the 2011-12 figures of Rs. 25,254 Crores; but the inflation in Health services
nullifies the impact of this minimal increase in public funding for health system. That much is
welcome. But the hope was that the government would also announce that it would fill all
vacant posts of doctors and health workers establish more health centres to meet the current
shortfall, and ensure adequate supplies of free medicines. But the budget document dismisses
these important issues in four meagre sentences, without any sign that it intends to take any
action on the matter.
This discriminatory approach continues to set the agenda even though the growth rate is
showing a healthy trend. As a result, the paucity of basic health services is becoming endemic.
A recent high-level expert report picks out healthcare as the sector most urgently in need of
investment and urges the government to ensure such investment through the Planning
Commission. Yet we continue to allocate a dismal 1.2% of our GDP to government health
services when the allocation should ideally be around 3%. This shortfall is seriously affecting the
healthcare infrastructure and the biggest sufferers are the common people.
Today India is known globally as the country where the largest number of infants die before
their first birthday, where the largest number of women die during childbirth, where more than
half the worlds lepers (130,000) live, and where 21% of the worlds TB afflicted (19,00,000) are
to be found. As a nation, we have been careless and insensitive about the health of our people.
This is the distressing truth. In 2011, the annual per capita expenditure on health was Rs. 2,500,
of which the governments contribution was a paltry amount of Rs. 675, with the people
shouldering the remaining Rs. 1,825. Many of them have descended into indebtedness as a
result of this additional burden. Equally distressing is the fact that last year the annual per
capita allocation for medicines was Rs. 43 and just 5.4% of the population could avail of free
medicines.
According to the Report of the Planning Commissions Expert Group on Health; As many as 2.47
million doctors, nurses and health workers are still needed to adequately staff the existing
primary healthcare system. If it is to be expanded to meet the real needs of our society,
another 6, 26,000 doctors and 49, 69,000 health workers would be needed. According to the
Planning Commission, the country needs an additional 187 medical colleges, 383 nursing
schools and 232 ANM training schools to meet our healthcare requirements but there seems to
be little resolve on the part of the government to set up this infrastructure.
Does the budget reflect any concern for this shortfall? Is the government at all serious about
ensuring peoples fundamental right to healthcare? You decide!
The message it gives is that healthcare is not a focal concern of the government at the moment.
Maybe the cost of treating HIV may come down a little. But what else? The government had
been making noises about setting up a national health mission to replace the national rural
health mission this year but the budget gives no indication that any action on this initiative is
likely. The government had also said it intends to supply free medicines through its health
services and even estimated the cost at Rs. 30,000 Crores. But the finance ministry shot down
this proposal.
All present health indicators point to a dismal situation. Expensive privatized healthcare
services are driving people deeper into poverty and indebtedness. The system continues to be
unaccountable to the people for its actions. And there is absolutely no indication on the part of
the government that it will ever look at primary health services as a basic right and take up their
provision as a priority issue.
Do we really have legal framework in place? Certainly not and that is why there is no
mechanism to ensure that state health institutions deliver Health Services as matter of Human
Right and on the other side no regulation to make private health sector accountable and
responsible exists. I am quoting a message from a civil society organization - Social Jurist; which
says Delhi Government after Honble Supreme Court upheld Delhi High Court judgment dated
22.03.2007 in Social Jurist PIL on September 01, 2010 has now moved to recover from 43
identified private hospitals unwarranted profits having been made by these hospitals by
denying free-treatment to poor patients during the relevant period in accordance with the land
allotment clause. The Directorate of Health Services, Government of NCT of Delhi by its letter
dated 06.03.2012 has sought detailed information from all the 43 identified Private Hospitals in
the prescribed Performa within one month in order to determine the amounts to be recovered
from each hospital to be used as corpus for the welfare/treatment of the poorest in the
Government Hospitals as per the directions of the Honble Delhi High Court.
The Honble Delhi High Court in Order dated 22.03.2007 in Social Jurist amongst others held, -
There is no justification whatsoever on the part of the General, Specialty or Super Specialty
hospitals not to comply with the mandate of the condition. Thus, they would be asked to make
good of the non-compliance of the condition and they must repay to the authorities and the
society at large for the unwarranted profits, at the cost of the poor, made by them for all these
years to the extent of the percentage of free-patient treatment (in terms of money)
proportionate to the number of patients treated by them during the relevant period and they
must pay that money to the authorities who shall create a central corpus/pool which shall be
utilized for the welfare, health-care and treatment of the poorer section of society in
Government Hospitals. A Division Bench of this Court in its order dated 07.11.2002 (referred
Supra) had passed such a direction. Despite orders of this Court from time to time, the hospitals
which were in default persisted with the same and showed complete disobedience to the
orders of the Court. The conduct of these hospitals even during the pendency of the writ
petition is not worthy of any appreciation. Rather, it would tilt towards denial of relief on
equitable grounds. Thus, we direct that a special committee shall be constituted which shall
carry out these directions in its best wisdom and which shall ensure that the directions of the
Court are neither diluted nor rendered ineffective by such steps.
It is unfortunate that despite High Court and Supreme Court orders, some of the identified
private hospitals like Mool Chand Karaiti Ram Trust and Hospital, St. Stephens Hospital and
Rajiv Gandhi Cancer Institute & Research Centre are still not at all providing free-treatment to
the EWS patients. The present step of the Government to recover unwarranted profits from all
the erring private hospitals would certainly go a long way in implementation of the Court
Orders in accordance with which such private hospitals on public lands allotted to them on
highly concessional rates are obliged to provide totally free-treatment to EWS patients to the
extent of 10% IPD and 25% OPD.
In India, Health services are covered under Essential Services; but very often doctors in Public
Health System especially go on strike for pressurizing governments for fulfilling their demands;
mostly to seek hike in salary, permission for private practice. There is a rule that every doctor
willing to study post graduate, would have to serve 3 years in rural areas; but doctors along
with the private market have been successful in reducing this time period from 3 years to 1 year
and now they are working hard even to get this period also removed from the state policy.
 In the absence of peoples rights to healthcare
and nutrition
What are the dynamic and convenient aspects Public Health and Nutrition? There are two
aspects to peoples rights to healthcare and nutrition. First is their fundamental and eternal
characteristics; Health primarily does not mean a health facility; it is conceived as notion of well
being. Second is the practical aspect of ensuring their implementation. Policy makers suffer
from a degree of ambivalence; as we have a regime which only wants to deal with Health
institutions and not interested in peoples well being. They cannot seem to decide whether
health services should reach the people or whether the people should reach health services to
avail of the benefits.
We arent talking about super-specialty health care services, which remain a distant dream, but
of basic and primary health services, which are moreover anyway out of the access of the
people in the present context, given the dysfunctional condition of the primary healthcare
infrastructure; because Health is not a right anymore in Indian system; its a service; it can be
provided and it may not; its a non-obligatory elemental service.
When it comes to analyzing peoples rights to healthcare one cannot take a neutral stand. You
need to take sides. The side we take is of the deprived and marginalized sections of our society,
of children, women, and the differently-abled, dalits and adivasi communities.
I would like to relate a tale of two villages in Shivpuri district of Madhya Pradesh (one of the
biggest state in India having highest proportion of malnourished children in India), a district
largely inhabited by the primitive Sahariya scheduled tribe community, to show how the
peoples right to healthcare and nutrition are made to disappear in a welfare state.
One of these villages is Kakra, which lies about 8km on the road from Pohri development block
and has 45 children aged below six years. On a visit to the village we came across many children
busily cracking a ber-like nut to get to the kernel, which they were eating with relish.
I asked them what exactly that fruit was and where they got it from. Their answer shocked me.
Pointing to a nearby pile of cowdung, one of them told us that their cattle ate the fruit while
grazing in the nearby forests, digesting its skin and pulp and excreting the seed in their dung.
Thats where the children rummaged for the seeds, which they called ghonta or ghonti.
It was then that it struck home how alarming the situation is. Adivasi communities forage for
forest produce to fill their stomachs. Some of these minor produce are highly nutritious but a
look at the children showed us how much in dire need they were of state intervention to meet
their nutrition needs and keep starvation at bay.
We visited some of the houses in the village, sat and talked to the people. Every house had
about 10-to-20kg of wheat. That was it. There was no sign of any other foodstuff anywhere. And
even this grain came to them courtesy the public distribution system.
In not a single house had dal been cooked for the past 20 days. Young children sat in the laps of
their mothers or dadis, eating rotis. Just plain dried rotis. At that moment the concept of
nutrition appeared like a figment of the imagination, dreamt up by experts sitting in distant
airconditioned offices. Here in these homes it stared us in the face by its very absence.
For drinking water the women had to cross the road and descend about 600m down the hillside
to where two hand-pumps had been installed. These were the only sources of water in the
village, with no sign of even a single tank.
When it comes to health, we, as a society, would like to see an anganwadi in every habitation
and village. A mini anganwadi has been opened for Kakras 45 children aged below six years. But
all they get in the name of nutrition is some packaged food.
An anganwadi worker was appointed two years ago but has yet to receive any training. She gets
a remuneration of Rs700 a month but hasnt been paid for the past seven months. No one
knows how this figure was arrived at so it would appear that the state discriminates even here,
dividing anganwadi workers into different classes.
The anganwadi doesnt have a weighing scale. Most of the children looked sick, their bodies
swollen, suffering from skin rashes and infections. There is a hospital 8km away but it is a
hospital only in name. It has no medicines and not a single lady doctor.
People have to travel 44km to the Shivpuri district headquarters to get any kind of medical
investigation done. But these investigations are prohibitively expensive for families where the
daily per capita consumption is a meagre Rs15. For them, health services will always remain a
distant dream.
There is another village nearby. About 20km from Pohri in Eswaya panchayat, Ahera has a total
of 110 households, the people belonging to a branch of the Sahariya community. Around 50 of
these families migrate every year in search of work and usually return by April end or the
beginning of May. This is the time of the year when almost the entire village is in the grip of
illness.
The houses in the village are thatched or have slate roofs. People say the summer heat has
been merciless over the past few years and it is becoming increasingly difficult to live through
the season. The women and children spend the day in the sparse shade of trees.
Getting clean drinking water is a daily challenge. The village has three hand-pumps but they are
all dysfunctional. The women have to walk over a kilometre to a stream flowing in the nearby
forest to collect muddy and unhygienic drinking water. Thats why vomiting and diarrhoea,
fever and infections are endemic.
The village has a primary health sub-centre but it is mostly inhabited by domestic animals. It has
been more than six months since the ANM and health worker last visited the centre. Which
means no vaccinations or health check-ups have been done for the past six months. There are
also no signs of any pre-natal or post-natal examinations ever being done here.
The Sahariya Peoples Alliance, a peoples organization, conducted a survey here in June 2011
and found 34 children suffering from serious malnutrition, of whom four have since died. Their
parents say they died of dehydration. Another 18 children were suffering from fever, diarrhoea
and other infections.
Poverty and livelihood insecurity are the reasons why the mothers and fathers cannot keep
their children for long at the nutrition rehabilitation centre. It is erroneous to assume they are
irresponsible and dont care. The real crisis is that if they dont work for a day the other
members of the family would face a grave situation.
So talking about health and nutrition of children is an exercise in futility as long as we cannot
first guarantee security of the means of livelihood of the parents.
The Constitution of India and the laws enacted within its framework do not recognize
healthcare and health security as a basic right of citizens. The fundamental rights it enumerates
define the political rights of citizens. The state is obliged and duty bound to implement these
political rights and if they are abrogated any citizen can approach a court of law.
Social and economic rights such as the right to health, nutrition and livelihood are part of the
Directive Principles of State Policy. The state can formulate policies or plans to implement these
rights but is not obligated to ensure that they are successfully implemented and everyone can
avail of their benefits.
According to Article 41 of the Constitution, the state shall within the limits of its economic
capacity and development make effective provision for securing the right to work, to education
and to public assistance in cases of unemployment, old age, sickness and disablement, and in
other cases of undeserved want.
,feiler ytinretam dna krow fo snotiidnoc enamuh dna tsuj rof noisivorp eht ot setaler 42 elctirA
syas 47 elctirA elihwthe state shall regard raising the level of nutrition and standard of living
of its people and improving public health among its primary duties. In particular, the state shall
endeavour to bring about prohibition of the consumption - except for medicinal purposes - of
intoxicating drinks and of drugs that are injurious to health.
Apart from these constitutional obligations, India is also a signatory of the UNs Universal
Declaration of Human Rights. But this declaration becomes valid and meaningful only if the
country formulates the constitutional framework and laws and provides the resources for its
implementation. This is the reason why despite India also being a signatory of the International
Covenant of Civil and Political Rights (ICCPR) and the International Covenant of Economic, Social
and Cultural Rights (ICESCR), communities that are deprived and discriminated against cannot
claim the benefits of their right to healthcare and nutrition
According to Article 12 of the ICESCR, the states that are a party to the covenant must
recognize the right of everyone to the enjoyment of the highest attainable standard of physical
and mental health.
Yet what we see is that the people of India, both at the individual and community level, have
been excluded from every initiative at every level (policies, programmes and implementation)
undertaken in the government system (Indias deprived communities 2007 Sehat Mumbai
report).
Human rights mean the rights of every individual, without discrimination, without excuses,
without exclusion. But because living a healthy life and availing of health services when one
falls ill are not defined as human rights the availability of these services depends on eligibility
(below poverty line) and other conditions.
The problem is that there are contradictions inherent in the eligibility conditions such as the
poverty line. The process of situating the poverty line is riddled with contradictions. They have
resulted in an impractical and callous definition of poverty that can be seen as a major factor in
abrogating the basic rights to food, nutrition, health and social security of a large section of the
population.
Indias caste and class-based structure has already divided society along social and economic
lines. The class that controls power the patriarchal upper castes - has used this power
insidiously to make the deprived classes - dalits, adivasis, women and children - believe that
their betterment lies in the hands of the very forces that represent this ruling class.
Development and change cannot be defined by a predetermined ideology. To a person with
economic wealth development means accumulating more wealth. But can economic wealth
alone serve as an indicator of development? Take the case of a dalit? Should there not be a
social angle to development in addition to the economic one? What if the poor dalit is a
woman? And suppose this woman is physically handicapped? What would development mean
for her?
One needs to take into account these different facets of deprivation in the Indian context. A
society based on caste-class differences and gender discrimination that has been in existence
for almost 5,000 years has effectively destroyed that core in peoples minds from which springs
the hope that the state and the powers that be are for their benefit and betterment and they
can stand shoulder to shoulder with them.
See how the story of discrimination unfolds. The Indian government decides that every child in
the country should be vaccinated against specific diseases to prevent their spread and save
countless lives. The required resources are distributed. But one sees fewer resources being
distributed in some districts of the country. These unfailingly happen to be dalit and adivasi
majority districts. They get fewer resources because the people distributing the resources have
at some level unconsciously accepted the upper-lower caste ideology.
Even if the resources do reach the grassroots one needs to take into account the person who
will be vaccinating the children. Class considerations again play a part in deciding whether the
children are vaccinated or not.
The dalit villager is also brainwashed into accepting the system. A camp is set up nearby in the
village to conduct medical examinations. The dalit sees whats going on but doesnt go to the
camp because he hasnt the slightest hope that such a camp could be set up for him.
Or take the case of the anganwadi in a village. It is supposed to dispense six services in addition
to providing nutritious food. These services are seldom available. But the people do not raise
their voice in protest. Even when the centre does not open its doors, which is not uncommon,
they remain silent. Where do the resources meant for them go? They do not ask, nor do they
demand accountability from the government.
Here again the basic reason for their passivity is that they cannot believe the anganwadi is also
meant for their children.
Our biggest lapse as a nation is that we have enacted a law to eradicate social discrimination
but have made no attempt to free the minds of those who implement the law of their ingrained
mentality of social discrimination. Nor has any campaign ever been conducted while enacting
these laws or formulating development plans to build up in the deprived sections - women,
children, dalits, adivasis - the faith and belief that the system being developed is for them, is
their system.
This lack of belief in the system is why the question of rights to health and nutrition has never
been seen as a fundamental issue by our society.
India has the highest infant mortality rate in the world. The largest number of child deaths
occurs because of diarrhoea, pneumonia, malaria, anaemia and measles. The government is
aware of the situation so it makes health programmes and implements them to arrest the
death rate. But these programmes never embrace the deprived sections of our society because
of the existing social reality.
The sad fact is that people from outside are brought in to implement these strategies for the
village. These imported people bring along their ingrained behaviour patterns with them. This
approach to solving social problems points to a serious lack of dialogue between government
and society on the existing social reality.
Another distressing fact is that the deprived community itself does not see child deaths as a
serious problem. Thats because they accept them as their destiny. When we question them
about the four children who have died in the village and the two who are seriously
malnourished and ask why they were not taken to the nutrition rehabilitation centre or the
government hospital they reply: Who listens to us? We are shooed away. There is no one to
attend to us.
They continue in this vein: When we ask for proper treatment they make it appear like they are
doing us a favour by serving us free. They even ask why we produce children if we cant look
after them. Did the government ask you to produce them and bring them here, they ask? So we
sell whatever little we have in our homes and go to a private hospital for treatment. Those who
have nothing left to sell just wait for death to come.
The government believes that this discriminatory state of affairs will resolve itself with
economic development. However, while liberalisation and infrastructural development has
seen the rapid expansion of health services they have failed to establish them as a basic right.
The health services are not universal but are getting more and more selective through private
sector participation.
The nation has been divided by the poverty line. It has been the accepted norm since 1973-74
that those who consume less than 2,400 calories in rural areas and 2,100 calories in urban areas
would be categorised as poor. So the poverty line was drawn on the basis of the daily per capita
expenditure required to ensure this minimum calorie consumption.
In 2004-05, the daily per capita expenditure was calculated at Rs12 for rural areas and Rs17 for
urban areas. In 2009-10 the figures were Rs26 and Rs32 respectively. On this basis it was
estimated that around 37% of the population, or 420 million people, were living below the
poverty line.
The country is facing an employment and livelihood crisis and people are unable to meet the
cost of their basic requirements from their personal incomes. But the governments policy
making economic experts and corporate supporters juggle figures to show that poverty is
declining in the country.
The Planning Commission once again juggled the figures in March this year. This time they
reduced the daily per capita expenditure to Rs22.42 ($0.45) for rural areas and Rs28.35 ($0.56)
for urban areas to set at a new poverty standard to show that poverty was declining. This figure
includes the expenditure on food, health, clothing, education, entertainment and social
interaction.
Using this new standard, the Planning Commission claimed that poverty had declined from
41.8% to 33.7% of the total rural population and from 25.7% to 20.9% of the urban population.
In this way, it was claimed that India now had 50 million less poor.
The Adivasi Dalit Sangathan, a peoples organisation in the adivasi regions of the country,
conducted a small survey in the areas where it is active to find out how much people had to
actually spend to fulfil their daily requirements. It found that food alone required a daily
expenditure of Rs19.
Around the same time, the National Commission for Enterprises in the Unorganised Sector
(NCEUS), an organisation set up by the Indian government, reported that 77% of the population
was living on less than Rs20 ($0.40) per day.
The debate on fixing the poverty line that has been going on since 1997 clearly shows that the
economic experts who formulate the countrys policies are neither unbiased nor practical. They
know little about deprivation in our society so they have been making policies that have further
deprived the poor and backward sections of their rights to health, education, food and social
security.
This is the reason why GDP continues to rise while human development, social security and
equality indicators continue to deteriorate. Because the rights to health, cheap rations, social
security etc are not universal in India the web of poverty becomes even more deadly. The only
ones who stand to benefit from the governments welfare schemes are those who qualify as
poor under the official definition of the poverty, which is itself riddled with contradictions.
The government appointed Sengupta Committee has pointed out that 77% of Indias
population needs to be considered as poor, but the Tendulkar Committee claims only 29.9% of
the people are living below the poverty line. If the 2011 census is taken as the base it means
only 36.17 crore people in the country are poor. The reality is somewhat different, with around
93.17 crore people battling with deprivation and multi-dimensional poverty. But the
government doesnt consider these additional 57 crore people as poor.
These people have to go in search of treatment to the open market where health services are
prohibitively expensive. The government has till now not set up any official monitoring
mechanism to control costs in these health centres that are run as a profit-making industry.
This leaves them free to raise their fees whenever they feel the need, with the patients having
no choice but to pay.

The government began adopting liberalized policies to reform the economy in 1991. Ever since,
strengthening the government healthcare system has never figured as a policy priority. Instead
the government has sought to encourage the private sector by giving tax concessions and land
at subsidized rates, leading to the emergence of a commercial market in healthcare and
nutrition.

The Centre for Insurance and Risk Management and the International Food Policy Research
Institute conducted a study in June 2011 in two districts of Madhya Pradesh in which they
found that 40% of rural families face an economic crisis every time any member of the family
fell ill. The study revealed that families were indebted to the extent of Rs78,828 on average. In
17-to-18% of the cases, loans had been taken for medical treatment at 29% interest.

Madhya Pradesh has the dubious distinction of leading the country in the number of
malnutrition cases. In 1993-94, 44.4% of the states population was below the poverty line.
Current estimates put the figure at 48.8%. These are the people who comply with the Planning
Commission standard of Rs26 and Rs32 per capita daily expenditure for rural and urban areas
respectively. But the reality is that 89% of the population does not get adequate food to stave
off hunger.

The figures are frightening. Almost 6 million children are malnourished and 58% of women are
anaemic. Average longevity also compares unfavourably with other states of the country. But
the question is: whatever the average longevity, do people live their lives with respect and
dignity?

The lack of sufficient food leaves children malnourished. Malnutrition is not an illness. It is a
physical state, a cycle in which the child doesnt die but is debilitated. It leaves children
physically handicapped. Their ability to learn, understand and remember is seriously
compromised. The condition insidiously traps these sections of our society in perpetual
enslavement.

It isnt mere coincidence or chance that Madhya Pradesh has the most malnourished children
and the highest infant mortality rate, as well as the highest number of children who do not
complete five years of schooling or drop out of school. Their lives are effectively ended and
whatever little is left can never attain the goal that the government has determined in its
NREGA programme, which is that every individual must live a healthy life.

Madhya Pradesh has the highest number of children dying of diarrhoea, malaria, measles and
pneumonia. Thats because they are malnourished to begin with and do not have the immunity
to resist these diseases. As a result, 100,000 children die every year in this state alone before
they reach the age of five years.

We can quote more such statistics, alarming statistics, but the question is why isnt our society
affected by this data? Why doesnt it react?

It may surprise you to know that of the 30,000 children whose deaths were registered in
Madhya Pradesh in 2011, the cause of death was not stated in 61% of the cases. Or the
government claims it did not know the cause of death. Such a situation arises only because
society does not ask the government why children are dying and whether they can be saved.
Take the following example. Three children die in a village in Satna district. Another three die in
the same village and three months later there are more deaths. But the government twists
these statistics in a web of argument by listing endless possible causes for the deaths. In the end
it absolves itself of its responsibility, saying there is nothing it can do about the causes of the
deaths. Society too remains silent. The childrens deaths are attributed to their families and to
their destiny. It is their political fate as well but their deaths can in no way disturb the political
equilibrium.
I believe the government has a constitutional responsibility so its accountability should be fixed.
But who will determine this accountability? We labour under the hope that society will catalyse
government to perform its functions with a sense of responsibility. Do you really think a society
that sees nearly 100,000 children dying in its arms would be in a position to ensure the
government behaves responsibly?
The elders have their problems. So do girls and the youth. But children cannot articulate their
hunger or illness. Society does not understand their language. Why does this society which gives
and shares its happiness and believes in values fail to see the hunger of children?
Should we not ask ourselves the question whether we - our institutions and organisations -
really have a connect with our society or not? We target the government , but all that ever
happens is limited to an interaction between the government and us. Where does society fit
into this equation? Does it have any place in this debate and analysis that goes on endlessly day
after day? Laws are enacted, policies are formulated, the budget and system are discussed. But
who is all this for? Where are these people? Where do they figure?
I have learned from my personal experiences in Madhya Pradesh exactly why the HUNGaMA
report on malnutrition states that people have not even heard the word malnutrition, a word
the prime minister says is a national shame.
The 2008 and 2009 elections in Madhya Pradesh were fought almost entirely on the issue of
malnutrition. Whatever the reason, many advertisements were published and the media was
vociferous, talking openly about the issue, The government was our target as we brought all its
shortcomings to the fore. We wanted to fix its accountability. We wanted to point out that even
if children cannot voice their concerns, we who advocate peoples rights and support peoples
struggles would become their voice.
But as always it was the clique of ruling power brokers who triumphed in the elections and
once again took the reins of power. Why? The answer is simple. Malnutrition may have become
an issue for the media, voluntary organizations, political parties and researchers. And, most
importantly, it may have provided the opportunity for multinational companies to increase
their gross and net profits. But it never became an issue of the people, of society.
The priorities of government and society may be similar and interlinked. But the link is not a
living link. Thats why it is the priorities of the government that are reflected in its policies, not
the priorities of the people. The government has given itself a constitutional mandate to
become a profit-earning entity. Its sole objective is growth so it must generate income at any
cost. It has little interest in first creating a healthy society.
In Madhya Pradesh, too, the land lies desolate, robbed of its fertility. Its forests are being razed
and the people whose lives and livelihood were once linked to its resources are now joining the
ranks of the shelter-less and hungry in cities like Bhopal, Indore and Delhi. The government is
now busy formulating plans for their well being in these cities.
Why cant we see our society as a single interdependent unit? Are malnutrition and hunger
invisible? That can never be the case. Hunger is starkly visible. Yet society does not want to see
it. We have no stomach to see hunger or be aware of it. The concerned may view it with a
heavy heart. But those with a capitalist worldview tend to brush it aside into some hidden
corner where it becomes invisible.
When society degenerates to a level where malnutrition is invisible, how can it dream of
holding the government accountable?
The concerns of government and society are no longer the same. Society wants to be governed
by laws and plans while government is solely engaged in making them. But there is clear
evidence to show that the deaths of over 1,700 children in Satna, Rewa, Shivpuri, Sheopur and
Khandwa districts over the past 10 years are the result of hunger and malnutrition.
Over the past two years there has been an attempt in Madhya Pradesh to set up a system of
community management. But the government feels it is easier to manage healthcare with a
hospital and nutrition rehabilitation centre-based programme. It doesnt require much effort to
run such a system. All that is required is putting in place the required infrastructure and
buildings, purchasing the required equipment and buying and distributing packaged nutritious
food.
In these buildings there is no one who asks the question: Why are children hungry? The
government doesnt want to accept that the problem of malnutrition can be solved only if the
crisis of livelihood, food production and basic rights is first addressed. For such realization to
dawn, it must go to the people. But for that it must first learn to speak the language of the
people and it should tell them why their land and forests are being snatched from them.
Voluntary organizations and the government forget that food security is not an issue that can
be resolved by centralized solutions. It is an issue linked to the personal need of individuals and
their access to food. Thats why we need to focus on the individual and not address the
problem of starvation through a centralized approach. Thats why we need to understand the
logic behind the conspiracy to take children to hospitals and feed them special chemical-based
nutrient foods.
What this scenario makes evident is that health services and a healthy life are not seen as the
basic rights of people. This unwillingness to accept health as a basic right points to something
deeper than the contradictions in our economic policies. - to the very intentions of the state and
its perceived role.
The major responsibility of the state is to resolve the social and economic contradictions in our
society. But the present phase is one in which the state itself is working to institutionalise these
contradictions. It is creating a new class of the poor and deprived in our caste-based society.
When defining economic progress it refuses to accept the concept that it is only a healthy
society that can create economic progress. By selectively uplifting 20% of our population the
state is creating a bleak future for the country.
Do the budget and the policy priorities reflect any concern for this shortfall? Is the government
at all serious about ensuring peoples fundamental right to healthcare? You decide! Our
planning commission formed 7 expert groups to indicate the gaps, priorities and suggestions; a
lot of knowledge, data and information came out of this process; but at the same time the first
sentence of the webpage
(http://planningcommission.nic.in/aboutus/committee/index.php?about=12strindx.htm) tells the
meaning of the story Views expressed in the Steering Committees / working Groups are not
that of the Planning Commission.
 Does Madhya Pradesh still have the largest
number of sick people?
There is a popular marketing slogan by Madhya Pradesh Tourism Department Hindustan ka
Dil Dekho (See the Health of India, which is Madhya Pradesh). Yes, see the health of our
country, which is seriously ailing. Thats not the end of the story; even after having worst health
and nutritional indicators, we are still consciously ignoring the importance and need of primary
and secondary public health care system. And on the other hand, the well functioning public
health and recognized institutions are being surrendered to the private health market; recently
Government of Madhya Pradesh has signed a MoU for initiating a partnership with a private
health service company Sri Arbindo Hospital to take care of Indores biggest Government
Hospital Maharaja Yaswant Rao Hospital and Government MG Medical Collage. Why is it that
the image that leaps to the mind when the words government hospital are mentioned is of a
filthy and foul smelling centre where ill-mannered behaviour of staff and corruption are the
norm? Why can I never believe that if I or any of my relatives fall ill there is no need to worry
because we can go to the government hospital to get our life back?

It is not as if we are looking for something special in a hospital but our faith in that institution
continues to diminish. At the same time, why exactly are quality health services moving further
and further beyond the reach of the common people? Is the government really committed to
providing the people with such quality services?
Around 80% of births now take place in hospitals or health centres in Madhya Pradesh. But 54%
of the posts for womens health specialists currently lie vacant and around 5,000 women
continue to die every year of birth-related complications.
Death is the final episode. But even if women do not die they are dogged by birth-related
problems throughout their lives.
A recent study shows that even in todays more open society women still do not have the right
to express an opinion about their health. Nor do they have the right to decide whether to have
a child or not. In a still predominantly patriarchal society they have no right to decide whether
to undergo a complete medical examination, eat proper nutritious food or get vaccinated.
Our society robs people of the right to healthcare on the basis of gender and caste
discrimination. We had once hoped that the government would rectify the situation. Instead, it
seems to be addressing the problem by adopting a route that is aggravating the problem rather
than resolving it. In 20 years of accelerated economic progress since the liberalisation process
was introduced India has committed the policy-level crime of consolidating healthcare as an
institution-based service.
As a state, India doesnt give healthcare the status of a right. That is why it has never ever
suggested, leave alone announced, any intention to define a healthy life and health services as a
basic right of its citizens. If the state doesnt have the resolve, democracy can only lead our
society into sickness and the government will end up ruling a sick state.
The kind of policies being formulated and implemented in the context of the health sector
throws up questions and doubts about the nature and intentions of the state, the political
system and its representatives. We can no longer trust the government to set up an effective
and accountable system to treat the illnesses that afflict us.
Two organisations recently conducted a study of the budgetary allocation for childrens health in
Madhya Pradesh. They found that on average a meagre sum of Rs52 was being allocated
annually for each child for their health. This is a state that has the highest infant mortality rate
and every year around 100,000 children do not live to celebrate their fifth birthday. And the
government spends just 14 paise per day on health for each child living here.
Every year malaria spreads in epidemic fashion in different parts of the state and it practically
devours the weak. But in Jabalpur district the posts of district malaria officer, assistant malaria
officer and malaria inspector lie vacant.
We had hoped that the National Rural Health Mission would revitalise the health of the
healthcare system in a time-bound manner during its tenure. The mission is in its final year and,
instead, it stands accused of the crime of shrouding the right to health for the benefit of
planning.
The question is: What should be the basis for determining the role and accountability of the
government? We feel that if the state is truly intent on ensuring that children, women and the
deprived receive quality health services and respect without discrimination, that people do not
die of neglect and carelessness at the policy level rather than illness, the first thing the state
needs to do is invest in health.
People can contribute to development only if they are healthy and happy. Oherwise a sick
society that harbours doubts about whether its people can survive can never be part of a nation
that repeatedly talks of 7, 8 and 9% GDP growth rate. This growth rate illuminates the lives of
only a special and miniscule class of people who can afford to pay the cost of expensive health
services available only in the private sector. Here it is pertinent to repeat a conclusion drawn by
the Prof Sengupta committee that 77% of Indias population live on less than Rs20 per day.
The Madhya Pradesh government recently presented its annual budget, claiming to have made
economic progress. But can it truthfully say that it is fulfilling its role of making the dream of a
healthy and happy Madhya Pradesh a reality? If it claims its answer is yes then I would like to go
into a few details to present a more truthful picture.
The 2012-13 budget has a per capita allocation of Rs404.40 for health. The state says if you
want free treatment then you should be listed in the BPL survey and make yourself a Deendayal
Upadhyaya card, which will entitle you to Rs30,000 worth of free health services. Will you be
sent out of the hospital if your cure isnt effected within this limit? The government has no
answer to that questiion.
There is a total provision of just Rs460 million for the states 6.9 million poor. If you work out
the mathematics you will see there is something seriously wrong somewhere.
There is an intimate link between health indicators, the governments intent and the
distribution of the required resources. If quality health services are not free to the people the
health indicators of the state would be dismal.
Kerala has the lowest infant mortality rate in the country 13 per thousand live births. The
maternal mortality ratio is 80. In Tamil Nadu the infant mortality rate is 24 and the maternal
mortality ratio is 97. But in Madhya Pradesh the infant mortaliy rate is five times higher at 62
and the maternal mortality ratio is a very high 267.
Is this situation a reflection of the states intent, concerns and perspective? It would certainly
seem so because the system can never be changed without active state intervention. According
to the guidelines set by a high-level expert group, Madhya Pradesh should spent Rs1,500 per
capita per year at 2008-09 prices on health under the National Rural Health Mission, but the
actual expenditure was a meagre Rs352. That left Rs1,148 unspent.
Currently, the per capita health spend is the lowest in Madhya Pradesh. Kerala spends Rs1,061,
Tamil Nadu Rs1,104, Maharashtra Rs1,355 and Haryana Rs1,226. Against the standard annual
per capita health expenditure of Rs2,000 for special category states, Arunachal Pradesh spends
Rs3,563, Goa Rs3,148, Mizoram Rs4,500 and Sikkim Rs3,049.
In 2001-02, Madhya Pradesh spent Rs13 per capita on medicines, the total public expenditure
amounting to Rs792.1 million. In that year the national average was Rs18, with Kerala spending
Rs38.9. Ten years later in 2010-11, Madhya Pradesh spent a total of Rs1.22 billion, the per capita
expenditure being Rs17.1. This amount would suffice for a three-day dosage of medicine for a
common fever. The national average in that year was Rs43, with Kerala spending Rs72.3 and
Tamil Nadu Rs65.
According to the high-level expert group set up by the Planning Commission in 2011, there
should be 5.1 doctors for every 10,000 people, or one doctor for every 1,952 people. The group
points out that Madhya Pradesh currently has 11 medical colleges for its 50 districts, and needs
a further 18 to meet its requirement of doctors. But the government does not seem committed
to investing in medical education. In the past 15 years, the total number of seats available in
medical colleges has increased by only 20%. This years budget has announced the opening of
another five medical colleges, none in the government sector, which shows that medical
education is now becoming big business for the private sector.
Sri Lanka has one hospital bed per 1,000 persons while China has three. The figure for India is
0.9. Madhya Pradesh has 32,000 hospital beds for its 72.59 million population or one bed for
every 2,268 persons, or 0.44 bed for every 1,000 persons. The situation is even worse in rural
areas where the availability is 0.25 bed per 1,000 persons.
The Planning Commission itself admits that the privatisation of health services is one of the
main reasons for the indebtedness of the poor. But it is the agency that is stopping health from
being declared a basic right.
We must pause to consider whether there is a direct link between health and poverty. It would
seem there is. In 1994-95 poverty declined by 12% from 31.3% to 19.7% in Kerala. Similarly, in
Tamil Nadu poverty declined from 44.6% to 28.9%. But in Madhya Pradesh it rose from 44.6% to
48.6%.
What we need to see is whose development is happening, whose lives are being changed when
the government talks of economic development. If the government decides to take up the
responsibility of assuring people of a life of dignity as their incomes rise and not leave
everything to the fortunes of the open market only then would our hopes rise. Otherwise there
is no hope.
In 2011-12, the Madhya Pradesh high court, responding to two petitions about the dismal state
of maternal healthcare facilities, ordered the government to improve the condition of its
hospitals, make the required medicines available and ensure that proper medical examinations
were carried out. It said the facilities should be up to the accepted standards, pointing out that
it is the government itself that sets these standards and then flouts them.
This is the biggest challenge that the government becomes accountable.
 Nutritional Poverty in India-2012
Increasing Nutritional Insecurity vs. Decreasing Poverty
A conspiracy of a callous state

In January 2012, the Government of India pointed out in its report on the state of
nutrition in the country that the average daily consumption of the rural population
amounted to 2,020 calories, against the standard norm of 2,400 calories. According to
the report, calorie intake in rural areas has been falling consistently since 1972-73 and
the story is the same for cities as well. This is not all. There has also been a significant all
round decrease in protein consumption.

In a second report released in February 2012, the government said that people in urban
areas spent Re. 881 (44%) of their total average monthly expenditure of Re. 1,984.46 on
food. The figure for rural areas was Re. 600.36 (57%) of the total average monthly
expenditure of Re. 1,053.64.

In March 2012, the Planning Commission in their new estimates stated that poverty had
been reduced by 7.3% in the country, which amounted to 53 Million people being lifted
above the poverty line.

So we have the strange paradox in India; even if Hunger and Nutritional Insecurity goes
up; Poverty will have to decline; because Planning Commission of India has decided to
show a decline!

The cost of living is rising, there is a crisis of employment and the central government says the
economic slowdown is limiting opportunities. Migration and displacement are on the increase.
Calorie and protein intake are consistently falling in the general population. People are
spending more from their pockets on education and health. Yet the Planning Commission has
reduced poverty levels by the wave of a wand (the government claims that there is no magic
wand to reduce corruption but every five years uses a magic formula to show lower poverty),
claiming that 5.4 million people in Madhya Pradesh and 53 million people across the country
are no longer poor. Its another matter that hungrier and more undernourished as compared to
five years back.

The country has been divided for long by the poverty line, with poverty being defined in terms
of the per capita calorie consumption. The standard daily per capita consumption measure
adopted by the government was the 1973-74 figures of 2,400 calories in rural areas and 2,100
calories in urban areas. The poverty line was defined in terms of the daily per capita
expenditure required to guarantee this minimum calorie consumption along with other
essential services. This amount was pegged at Re. 12 in rural areas and Re. 17 in urban areas in
2004-05. The Tendulkar Committee appointed by the Planning Commission enhanced the
poverty line to 15 rupees and 19 rupees for rural and urban areas respectively. Using this figure
as a basis, the government estimated that 37% of the population, or 420 Million people, were
living below the poverty line. Subsequently the as stated by the Planning Commission in its
affidavit submitted in the Supreme Court in September 2011, the poverty line was revised to
Re. 26 in rural areas and Re. 32 in urban areas as in June 2011.

The country is going through a livelihood-employment crisis and people are unable to meet
their basic needs from their pockets because of the high cost of living, country as whole facing
an inflation tsunami; yet the governments economists and policymakers who favour the
Corporates are caught up in statistical jugglery to show that poverty has been reduced. This
decline is not real; it is the fabrication of a class of economists and policy makers working under
the influence of the international financial institutions and investors.

On March 19, 2012, the Planning Commission once again did its statistical jugglery, using a new
standard with a reduced daily per capita expenditure limit Re. 22.42 ($0.45) in villages and Re.
28.35 ($0.56) in cities to show a further reduction in poverty levels. This reduced figure
nevertheless factors in the expenditure on food, health, clothing, education, entertainment and
social interaction. The new calculation showed poverty levels falling from 41.8% to 33.7% in
villages and from 25.7% to 20.9% in cities. In this way, more than 50 million people were
virtually lifted out of poverty.

The Planning Commission claims it has used the data and equations proposed by the Tendulkar
Committee to determine the poverty line. Its calculations are based on the NSSO data of per
capita monthly consumption expenditure. When the NSSO calculated the per capita
expenditure in 2004-05 it did not include the expenditure incurred by the state on the mid-day
meal and anganwadi programmes. However, these amounts were included in its new 2009-10
calculation, which naturally inflated the per capita monthly consumption expenditure.

How much of an impact these welfare programmes had on the lives of people is a matter for
debate, but what is certain is that they contributed concretely to determining the poverty line.
If the MDM and ICDS expenditures had not been included in household expenditure, that itself
would have reduced the claimed decline in poverty by 1.7% (i.e. if these were not included the
government would have been able to claim a decline of 5.7% and not 7.4%)
The Jagriti Adivasi Dalit Sangaathan, a peoples organization active in the adivasi dominated
areas of the country, conducted a sample survey in its area of operation to find out how much
people actually spend to fulfill their daily food consumption requirements. They found that
Rs19 was spent daily on food alone.

It was during this time that the Indian government set up the National Commission for
Enterprises in the Unorganized Sector (NCEUS) for the unorganized industrial sector. The
organization reported that 77% of Indias population lived on less than Re. 20 ($0.40) per day.
The debate to define the poverty line, which has been going on since 1997, clearly reveals that
our policy making economists are neither unbiased nor practical. They have little knowledge of
deprivation in our society but are busy making policies that deprive the poor and backward
classes of their right to health, education, food and social security. This is the reason why GDP
continues to rise while human development, social security and equality indicators continue to
deteriorate. In India, the rights to health, subsidized food, social security etc are not universal.
That is why the web of poverty is so deadly. The only ones who stand to benefit from the
governments welfare schemes are those who qualify as poor under the extremely
discriminatory, illusory and weird officially accepted definition of Poverty.

The government appointed Sengupta Committee {The National Commission for Enterprises in
the Unorganized Sector (NCEUS)} has said that 77% of Indias population needs to be
considered as poor because they survive by spending less than Re. 20 a day; but the Tendulkar
Committee claimed only 37.2% of the people are living below the poverty line. If the 2011
census is taken as the base it means only 360.17 million people in the country are poor. Again
Planning Commission further has adjusted the figures in 2012 and declared that poverty in India
has come down to a level of 29.9%. The reality is something quite different, with around 937.17
million people battling with deprivation and multi-dimensional poverty. But the government
doesnt consider these additional 570 Million people as poor.

The situation is awash with contradictions. The Planning Commission says poverty has been
reduced but it will not use the new data to determine who should qualify as beneficiaries of its
welfare and anti-poverty schemes. It says the figures only go to show how effective the
economic policies adopted by the government (privatization and liberalization) have been in
reducing poverty.

However, the truth is that this data is used and will continue to be used to determine who
should qualify for distribution of subsidized rations under the public distribution system and to
determine eligibility for many other welfare schemes such as, social security pension, free
health services and even water at low rates will be provided to persons living Below the Poverty
Line.

Or take the case of the Madhya Pradesh government. One day it declares that poverty has been
reduced because of its welfare schemes. But the next day ruling political party stridently calls
for an agitation against this poverty line conspiracy of the central government.

The actual fact of the matter is that 2,000 farmers are turning their backs on agriculture daily
and One Million children die of malnutrition every year. While obtaining a full meal is becoming
a distant dream for more and more people, the government is busy spinning its web to give
poverty a more concrete definition that would exclude these impoverished people from its
purview. The policy appears to be to let the poor die because that would inevitably lead to a
reduction in poverty levels.
Every year a global analysis is made to assess how countries around the world fare on the
human development indexes. What is becoming starkly evident is the growing gap between
economic growth and human development indicators in the case of countries like India, which
is universally seen as an emerging economic superpower with rapidly growing inequality. Its
record on the social and human development fronts has been consistently dismal. I think it is
necessary to analyze inequality in the country on the basis of these human development
indicators. As a country, we have always lived with a social system beset by caste and class
inequalities. We must chart a course of change and progress to break these inequalities.

Instead, we seem to have chosen an ideology that makes the increasing growth rate the focus
of our policy making. Our policy makers believe that inequality can be erased only with
economic growth and may be because of this believe less importance to the structural causes is
given. Now we are living in such a situation where economic inequality continues to persist in a
scenario of abject poverty. What is also now becoming clear is that the government is limiting
its constitutional role and duties in the pursuit of its new economic development policies. This
is reflected in limiting the scope of its welfare policies while commercializing and privatizing
education, health, drinking water and other such basic necessities and subjecting them to the
logic of market forces. Now along with caste and class differences, economic differences have
reached new levels. The number of billionaires and the super rich is growing while at the same
time more and more people fall in to abject poverty

A large middle class has also come into existence for whom the major concern is living a
comfortable life so it never raises any questions about why a large proportion of our population
does not have the wherewithal to acquire the basic necessities of life. Nor does it question why
the government also shows little interest in the betterment of this vast segment of the
population who die because they have no access to treatment or medication when they fall ill.
In the new dispensation, the government contributes just 26% of the expenditure on health,
the remaining 74% coming out of peoples pockets. According to yevruS elpmaS lanoitaN
noitasinagrO( noitatnemelpmI emmargorP dna scitsitatS fo yrtsiniM, Government Of India )
report No 540 on Nutritional Intake in India (January 2012), 57% of the monthly per capita
expenditure in rural areas and 44.4% in cities goes for food alone.

si saera larur ni erutidnepxe ylhtnom atipac rep eht taht tuo stniop troper emas ehTRe. 1,053.64,
hcihw foRe. 600. 36is spent on food .Education accounts for Re. 37. 79and health for Re. 56.91.
yrtnuoc eht fo saera larur lla ssorca emas eht tnsi noitautis ehT. secnereffid era erehT. larur nI
si erutidnepxe ylhtnom atipac rep eht ihleDRe. 2,068.49, hcihw foRe. 1,115. 75is spent on food .
In Bihar ,it is just Re. 780. 15 63% ihleD larur naht ssel. alareK nI, sR ylno843 atipac rep eht fo
fo erutidnepxe ylhtnomRe. 1,835. 22(45.93%) sevitanretla evah ereht elpoep os doof no tneps si
seitissecen cisab rehto rieht rof. dnuora dneps elpoep rahiB nIRe. 26. 15per month on health
services ,the figure in gnieb hsedarP ayhdaM Re. 39. 89and Re. 33. 06in Odisha .On the other
hand people in Kerala and Punjab spend Re. 165. 62and Re. 131. 05respectively on health.

ylevitcepser elpoep eht fo sdeen nietorp dna taf eht gnillifluf rof lativ era seslup dna slio elbidE.
hcraeseR lacideM fo licnuoC naidnI eht ot gnidroccA(RMCI) ,a household with five members
 should have 1.93kg of pulses per member per month .But official per capita monthly
consumption reports show that the consumption of dals has been falling in rur morf saera la
710 ni mg2004-05 ot650 ni mg2009-10 .A similar fall from 820gm to 790gm is seen in urban
areas during the same period .If seen from a human development perspective ,consumption is
particularly low in backward states like Bihar (558mg) ,Jhark dnah(531gm )and Odisha (532mg).

dnuora seriuqer nosrep A800 ni elpoep taht slaever atad tnecer tub htnom rep lio elbide fo mg
ylno gnimusnoc era segalliv550mg. yrtnuoc eht ssorca nevenu si noitautis eht niaga ereH, htiw
gnieb rahiB ni noitpmusnoc449 ,mgJharkhand 516gm ,and Odisha 452gm .Lower consumption
means lower stored energy resources in the body .But the matter does not end here .

fo smret ni ytrevop fo noitinifed ehTcalorie eb ot emac doof suoitirtun fo ytilibaliava ro ekatni

eht fo edaced eht ni detpecca yllareneg1970s. noitinifed siht ot gnidroccA, ssel tog ohw esoht
naht2,400 dna saera larur ni seirolac2,100 eb ot deredisnoc eb dluow saera nabru ni seirolac
enil ytrevop eht woleb. nI1972-73 ,the NSSO stated in its 27th Round survey that egareva eht
calorie saw saera larur ni ekatni 2,266 seirolac, fo dradnats detpecca eht tsniaga2,400 seirolac.

HHousehold
CO O
U SNE S
HUOConsumption
D P T I O Nof
LM Various Goods and Services in India O F D IF F E R E N T IT E M S A N D S

(N S S OSample Survey Organisation, Govt. of India; 66th Round Survey Report released in February, 2012)
National

Expenditur Bihar Jharkhan Uttar Orissa Madhya Chhattisgarh Kerala Punjab Himachal Delhi
e segment d Pradesh Pradesh Pradesh

Monthly
P er per
capita value Re. 780.15 Re. 825.15 Re. 899.10 Re. 818.47 Re. Re. 783.57 Re. 1835.22 Re. 1648.92 Re. 1535.75 Re.
of total 902.82 2068.49
expenditure

Poverty Line Re. 656.6 Re. 613.3 Re. 663.7 Re. 567.1 Re. Re. 617.3 Re. 843.0 Re. 830.0 Re. 708.0 Re. 747.8
- 631.39
Expenditure

Monthly
E x p e n per
capita Re. 504.81 Re. 502.81 Re. 520 Re. 507.00 Re. Re. 456.04 Re. 843.00 Re. 795.01 Re. 792.58 Re.
expenditure 503.58 1115.75
on food
items and
ratio of total
expenditure (64.70%) (60.93%) (57.83%) (61.94%) (58.20%) (45.93%) (48.21%) (51.60%)
in bracket (55.77%) (53.94%)

Monthly per
capita
expenditure Re. 275.35 Re. 322.34 Re. 378.28 Re. 311.47 Re. Re. 327.53 Re. 992.22 Re. 853.91 Re. 743.17 Re. 952.78
on non-food 399.82
items

Consumptio
n and
Expenditure 0.558gm 0.531gm 0.764gm 0.532gm 0.712gm 0.621gm 0.581gm 0.833gm 1.254gm 0.680gm
on pulses
(Monthly)
(Re. 26.74) (Re. 25.54) (R
Re.s
 (R
Re.s26.53) (R
Re.s29.58) 37.68) (R
Re.s32.22) (R
Re.s35.31) (R
Re.s43.77) (R
Re.s51.43) (R
Re.s43.53)

Consumptio
n and
expenditure 0.449gm 0.516gm 0.587gm 0.452gm 0.588gm 0.555gm 0.524gm 0.821gm 0.887gm 0.690gm
on edible
oils
(Monthly) (R
Re.s33.93) (Re. 35.18)
Rs (Re. 36.74)
Rs (R
Re.s29.12) (R
Re.s (R
Re.s34.18) (R
Re.s30.05) (R
Re.s50.71) (R
Re.s49.01) (R
Re.s49.07)
32.14)

Per capita R s26.15

Re. R s32.14
Re. R s65.85
Re. R s33.06
Re. R s39.89
Re. R s30.75
Re. R s165.62
Re. R s31.05
Re. R s82.75
Re. R s18.00
Re.
monthly
Expenditure
on health

In its latest report the organization points out that the daily per capita calorie intake has now
fallen to 2,020 calories. Take the example of Madhya Pradesh. In 1972-73, the intake in rural
areas was 2,423 calories but it is now just 1,939 calories. The situation in the urban areas is no
different. The intake was 2,229 calories 40 years ago but it has now fallen to 1,854 calories.
But the story of nutritional insecurity does not end here. There is a corresponding fall in protein
intake as well. In 1993-94, the national daily per capita protein intake was 60.2gm, which has
now fallen to 55gm. In Madhya Pradesh it has fallen from 63gm to 58.4gm rural areas and from
57.2gm to 53.5gm in urban areas.

Poverty Head Count Expenditure level Expenditure Calorie Consumption Protein

Ratio (Poverty line) on Food (per day)
Consumption
(% in Rural areas) (Per person per month in Re.) (in Re. Per (in grams per
month) day)

1993-94 2004-05 2009-10 1993-94 2004-05 2009-10 2009-10 1972-73 1993- 2009- 1993-94 2009-10
94 10

Madhya 49 53.6 42.0 232.5 408.41 631.9 503.58 2423 2164 1939 63.0 58.4
Pradesh

Kerala 33.9 20.2 12.0 286.5 537.31 775.3 843.00 1559 1965 1964 50.8 52.7

Uttar 50.9 42.7 39.4 244.3 435.14 663.7 520.82 2575 2307 2064 70.4 60.0
Pradesh

Rajasthan 40.8 35.8 26.4 271.9 478.00 755.0 646.55 2730 2470 2191 79.4 67.8

Jharkhand 65.9 51.6 41.6 227.7 404.79 616.3 502.81 NA NA 1900 NA 48.5

Orissa 63.0 60.8 39.22 224.2 407.78 567.1 506.75 1995 2199 2126 52.7 49.7

Punjab 20.3 22.1 14.6 286.9 543.51 830.0 795.01 3493 2418 2223 74.7 65.4

Himachal 36.7 25.0 9.11 272.7 520.40 708.0 792.58 NA NA NA NA

Pradesh

Delhi 16.2 15.6 7.7 315.4 541.39 747.8 1115.71 NA NA NA NA

Bihar 62.3 55.7 55.3 236.1 433.43 655.6 504.81 2225 2115 1931 60.2 53.6

Chattisgarh 55.9 55.1 56.1 229.1 398.92 617.3 456.04 NA NA 1926 NA 44.7

Gujarat 43.1 39.1 26.7 279.4 501.58 725.9 640.10 2142 1994 1882 55.6 54.0

India 50.1 41.8 33.8 - 446.68 672.8 600.36 2266 2153 2020 60.2 55.0
(total)

Data Source -
Nutritional intake in India, NSSO 66th Round Survey report No. 540, January 2012
Household consumption of various goods and services in India, NSSO report No541, February 2012
Planning Commission press note on poverty estimation, March 2012
Tendulkar Committee report on poverty estimation, 2010

The nutrition scenario has not changed for the poor since 1970, when major Food programs
started. The statement of Dr.Gopalan that if you fill the calorie gap, protein deficiency will
disappear is valid even today. Ex. Deputy Director of National Institute of Nutrition Dr Veena
Shatrughna by adding to this statement says But there is very little room for more calories
from cereals to fill this calorie gap in children and adults. Most of our food programs carry only
Rice and Wheat. Which not a ideal source for ensuring food security in totality. Actually Calories
must come from varied sources such as fats and oils, roots, vegetables, oilseeds, milk, eggs,
fruits like bananas, etc. to meet the massive deficiencies of calories, proteins and other nutrient
deficiencies. There is a saying in villages we must have different colour food in our food plate,
different colour food belongs to the variety of food. Knowledge about energy density of food
makes it mandatory that about 40% of calories are provided from fat for children between 6
months to 3 years. It is unfortunate that even before the calorie gap is filled micronutrients
deficiencies are being addressed with the use of chemicals as food substitute for 70% of the
population. We are still dependent on cereals for getting 60% of total energy and protein and
not getting enough other varieties of food.
There is a clear link between hunger and the definition of poverty. Hunger, in turn, is closely
linked to getting the required food for our daily energy and nutrition requirements. Since the
decade of the 1970s, those not getting this level of nutritious food have been officially
categorized as being below the poverty line.
If we look at the statistics of consumption expenditure in the different deciles of our rural
population, it becomes obvious that the poverty line is being used as a tool to present a
diffused picture of poverty and hunger in the country rather than reflect the reality. The
officially accepted daily per capita calorie requirement in rural areas is 2,400 calories. The
expert group set up by the government in 1979 has stated that anyone subsisting on food
providing less than this daily energy requirement would be classified as poor. It also decided
that the monthly per capita expenditure to define the poverty level would be arrived at only
after factoring in the costs of all basic necessities, in addition to the cost of the average daily
2,400 calorie requirement.
The NSSO report shows that only the top two deciles of the population - the most affluent 20%
- actually get the daily 2,400 calorie requirement, with the 9th decile having an energy intake of
2,326 calories plus 64.4gm of protein and 51.7gm of fat. The two deciles spend Rs827.34 and
Re. 1,156.00 respectively per capita per month for fulfilling their energy and nutrition
requirement.
Against this, the poverty line fixed for rural India provides for a per capita monthly expenditure
of Rs672.80, which includes the expenditure on health, education, transport, and leisure apart
from the basic food expenditure. This essentially means that the poor are in no position to get
even the minimum stipulated energy and nutrition requirements. To make that possible, the
expenditure for food alone should be fixed at Re. 827.34 per capita per month.
We cannot disguise the fact that 50% of the population the five lowest deciles - is forced to
spend more than 61.6% of its per capita monthly expenditure on food alone, after which it still
ends up with an energy deficit of 17.45% as per the stipulated calorie requirement.
As much as 80% of the population eight deciles, barring the top two - has a daily energy
intake of between 1,545 to 2,184 calories. That means 80% of the population is hungry and
poor, with no guarantee of nutrition security, if we apply the official per capita energy intake
standard. But the government refuses to accept this truth. Instead, it goes about redefining the
daily per capita calorie requirement to 1,990 calories against the 2,400 calories that has been
the accepted standard since the 1970s.
The NSSO report clearly shows that calorie intake depends on the economic level and
purchasing power of the people. The lowest decile the poorest 10% of the population
spends just Re. 294.03 per capita per month on food to get a mere 1,545 calories, plus 40.7gm
of protein. Compare this with the top two deciles that spend Re. 827.34 and Re. 1,156 per
capita per month respectively for their energy and nutrition requirements alone, with the tenth
decile getting 2,617 calories plus 73.8gm of protein.
No one can counter the argument that those in bottom two deciles have to do the most
physical labour to earn their daily livelihood. But these are the deciles that get the least energy
and protein because thats all they can afford to purchase. On the other hand, the top two
deciles get more than adequate energy and protein in spite of the fact that they do less physical
work comparatively.
This clearly brings out the anti-people mindset of our policy makers who are bent on concealing
the true face and extent of poverty by any means and at any cost.
One more fact needs to be reiterated. Nutrition security cannot be ensured solely by
distributing cereals to provide energy and some protein. Nutrition security is not about calorie
sufficiency alone. According to the National Institute of Nutrition, not more than 40% of our
calorie requirements should come from cereals, the rest coming from pulses, legumes, edible
oils, fruits and vegetables, meat, and poultry and dairy products, which provide other important
nutrients as well.
A recent government study shows that 90% of the population spends most of its money on
getting its energy requirements from cereals, the most deprived decile spending 72.7%, the
 next decile 68.6%, the third decile 66.7% and the fourth decile 62.5%. These deciles depend on
cereals for their protein requirements as well since their get only 8% of these needs from
pulses, milk and other sources.
The poor fall back on cereals to fight hunger because these foodstuffs are the cheapest
available and also fills their stomachs.

Status in different deciles groups - India Decile-wise expenditure % of % of

on food and non-food calories protein
(based on URP consumption) - Rural items coming coming
from from
Deciles % % Per capita per day intake Food Non- Total Cereals Cereals
expenditur expenditur of Food
e on food e on
cereals

Calorie Protein Fat

(Kcal) (gm) (gm)

01 66.5 27.8 1545 40.7 19.5 294.03 452.98 747.01 72.7 73

02 65.0 24.5 1711 45.6 24.9 375.00 584.40 959.40 68.6 69

03 63.7 22.7 1821 48.7 28.4 428.37 675.35 1103.73 66.5 67

04 62.2 20.8 1880 50.7 31.8 480.19 760.79 1240.98 65.1 66

05 61.6 19.6 1981 53.5 35.3 527.07 760.79 1287.86 62.5 63

06 59.7 18.0 2023 54.9 38.1 573.60 944.35 1517.95 61.4 61

07 58.1 17.1 2111 57.4 41.7 636.03 1062.93 1698.96 59.5 59

08 55.6 15.1 2184 60.3 45.9 704.38 1220.59 1924.97 57.3 57

09 52.1 13.3 2326 64.4 51.7 827.34 1470.33 2297.67 54.3 53

10 38.1 7.7 2617 73.8 65.5 1156.68 2516.69 3673.37 47.4 47

ALL 53.6 15.6 2020 55.0 38.3 600.36 1053.64 60.4 60

India

Source
TH
1. Household Consumption of Various Goods and Services in India, NSS 66 Round Report No. 541 (66/1.0/3)
th
2. Nutritional Intake in India, NSS 66 Round Report No. 540 (66/1.0/2)

A dispassionate assessment of the situation brings out the sad fact that the officially accepted
poverty line borders the starvation line. The poor are those dying of hunger. In rural areas the
official poverty line provides for a daily per capita consumption expenditure of less than Re.
672.80. But the reality is that the actual expenditure is even lower at Re. 600.36, (Information
not comparable) which gets a daily calorie intake of 2,020 calories and protein intake of 55 gm
against the recommended intake of 2,400 calories.
It is clear that the government equates expenditure on food alone as the basis for defining
poverty. Expenditure on health, education, social security and other basic needs get only a
nominal mention and form only a small part of the daily per capita consumption expenditure.
Many states in the country have experienced a sharp fall in average daily calorie intake over the
past 37 years (1972-73 to 2009-10). The fall has been 484 calories in Madhya Pradesh, 511
calories in Uttar Pradesh, 539 calories in Rajasthan, 1,270 calories in Punjab, 294 calories in
Bihar, and 260 calories in Gujarat, to give an all-India average fall of 246 calories. Only a handful
of states have seen increasing calorie intake, including Orissa (131 calories) and Kerala (405
calories). But even in these states, calorie intake is nowhere near the recommended standard
of 2,400 calories.
There is another serious question that needs to be answered. In calculating average calorie
intake we overlook the distributive aspect. Is everyone receiving equal nutrition? That would be
impossible in an unequal system where policies favour the perpetuation of inequality. Even
among the poor, there are vast differences. While the all-India daily per capita calorie intake in
rural areas is 2,020 calories, the poorest 10% get by on 1,545 calories. They also get only
40.4gm of protein against the daily per capita availability of 55gm, while the wealthiest get
70.5gm.. The data based observations derived from the NSSO report also alarms us that lowest
5 deciles (50% or the population) spends more than 61.6% of their total expenditure only on
food; whereas upper level decile (top 10%) spends 38.1% on food. The country, as a whole,
spends 53.6% of monthly per-capita expenditure on food. The variations in quantity of
consumption of calories, protein and fat is visible ; the difference in consumed calories vary
from 1545 Calories for the poorest to 2617 Calories the top decile; and top 10% consumes 73.8
gram protein and worst receives 40.7 grams. The different in fat consumption is literally
shocking worst 10% (poorest) manages to consume 19.5 grams fat per day and the top 10%
consume 65.5 grams fat every day. There is a 20% difference in the consumption level between
9th and 10th decile. The official poverty line does not recognize these variations at any point of
its explanations.
One must observe the massive difference in the expenditure and consumption figures between
9th and 10th decile. The 9th decile spends 52.1% of its MPCE on food; which sharply goes down
for the 10th decile to a level of 38.1%. In a sense, it is easy to understand the fact that inequality
multidimensional inequality plays important role for fulfilling the nutritional requirements.
The daily average per capita calorie intake in the rural areas of Madhya Pradesh is 1,939
calories. But the poorest 10% get only 1,375 calories, against 2,714 calories for the richest 10%.
The situation is the same with daily per capita protein availability. Against the availability of
58.4gm, the poorest 10% get only 39.7gm while the richest 10% get 84gm.
Now look at the situation in urban areas where daily per capita calorie intake is as low as 1,854
calories. The poorest 10% in urban areas consumes merely 1,395 calories while the richest 10%
get 2,359 calories.
If the government were to apply its own criteria for recommended daily calorie intake, 90% of
Madhya Pradeshs rural and urban population can be categorized as poor, because only the
richest 10% get the recommended intake. You can check out these figures in the NSSO report
No. 540 (January 2012) on nutritional intake in India.
This is a crisis period for all of us. People in India are living with starvation. Yet poverty
estimates are declining at a rapid rate. This is the myth the government wishes to prove. It
weaves a web of statistics to trap us in its deceitful conclusions in its attempt to prove itself
correct. But it can do this only by robbing the poor of their basic rights. This is the contradiction
that is so glaring and all too obvious. It is also obvious that the government refuses to accept
the truth for ulterior motives.
At the end; our food security policies, food production strategies and our very definition of
poverty conveniently overlook this reality of existing situation of hunger and food consumption
patterns. It is such studied indifference that have led to hunger and nutritional insecurity
reaching a level where 80% of our population doesnt get its daily per capita intake of energy
(calories), protein and fat, but nevertheless finds itself excluded from the BPL list that defines
who are poor and deprived in the country. After looking at number of experiences; we have
learned the fact that Poverty in India is a second challenge for its people; whereas the first
challenge is to encounter and defeat the definition of poverty adopted by Planning
Commission; which no more viewed as credible policy institution.
 Stunted Childhood in a growing economy
A case study of India
The present is a time of contradictions. The policies of the Indian state and its style of
governance exemplify these contradictions. So what exactly are these policies in Indias current
phase of development that beget contradictions, a phase in which the country is said to have
made unprecedented progress, clocking the highest-ever growth rates since achieving
independence from British rule?
Pause to digest the following statistic: 225,000 farmers who produce food-grain for the country
committed suicide in despair at their economic plight during this period of explosive growth.
When the country adopted liberalization and privatization as the cornerstone of its economic
policy in 1991, the daily per capita foodgrain availability was 510.10gm. In 2011-12, the
governments Economic Survey showed foodgrain availability had declined to 438.6 gm in 2010.
The picture is no different for pulses. In 1961, 14 years after India gained independence; the
daily per capita availability of pulses in the country was 60gm. It fell to 31.6gm in 2010.
During the phase when India was showcasing its remarkable progress to the world 42 percent
of the countrys population aged below five years a staggering 65 million children was
trapped in a web of malnutrition. It isnt coincidence or chance that the largest number of
deaths from pneumonia and diarrhoea occur in India.
A 2012 Unicef study points out that 609,000 of the 2,197,000 deaths from these two diseases
reported worldwide in 2010 were from this country. The organization draws attention to the
fact that these diseases require simple cures and are easily controllable if primary health
services are universally available.
It is a painful truth that 50 percent of the deaths from these diseases are registered in five
countries Nigeria, Congo, Pakistan, Ethiopia and India. The prime reasons for this predicament
are poverty, lack of basic health services, safe drinking water and sanitation, a governance
system lacking accountability, and economic development policies that eschew equality.
I do not see malnutrition as an accidental condition. It is the inevitable outcome of a situation in
which our economic, social and political policies ignore the basic duty of the state to seek a
permanent solution to the issue of food security.
In its initial phase, malnutrition isnt a condition requiring medical intervention. It isnt a disease
caused by a bacteria but the result of children not getting nutritious food according to their
developmental needs for long periods of time. Or it could result from sick children not receiving
adequate medical and rehabilitative care.
One serious outcome of their weakened condition is lowered immunity, which ensnares them
in a web of infection, making them more susceptible to illnesses such as diarrhoea, pneumonia,
measles, malaria, etc. Their physical and mental development is arrested and if their condition
degenerates to a critical level death may result.
Malnutrition needs to be seen as a social and economic crisis that robs people of their ability to
contribute their mental and physical labour for the well-being of society. The solution to
nutritional insecurity does not lie in our country of 1.22 billion people importing its foodgrain
requirements. It lies in recognizing our strengths our human and natural resources and our
pool of knowledge.
Unfortunately, we have adopted a policy of shamelessly exploiting and auctioning our
resources in the name of economic development. Our forests, rivers, minerals and biodiversity
are a heritage built up over hundreds of thousand years. We sell this heritage to showcase an 8,
9 or 10 percent growth rate.
What Ive said may appear to some of you to be a blinkered, one-sided view of development.
Yes, I do view development from a certain perspective, but it is not a blinkered view. It is the
perspective of 77 percent of the Indian people who achieve the feat of spending less than Rs20
to meet their daily life needs. It is the viewpoint of 88 percent of our population that is denied
the nutrition and calorific energy that the Indian Council of Medical Research says is the
minimum daily per capita requirement.
India harbours the ambition to become a member of the UN Security Council but it cloaks the
truth that the country is in the grip of starvation, malnutrition and a livelihood crisis, that one in
every two children is malnourished, that a third of the children who die every year in the world
are Indian, and that 8 out of every 15 women of child-bearing age are anaemic.
The Indian government conducts a National Family Health Survey every seven years to collate
information on social and other factors influencing the health and nutritional status of the
people. According to the third survey (2005-06), 42.5 percent of the child population is
underweight, 48 percent is stunted, and only 24.5 percent were breastfed within an hour of
birth.
The study shows that 39.8 percent of women and 46.7 percent of men consume some amount
of milk or dairy products daily, 36 percent of women and 41 percent of men do not get green
vegetables daily, and only 7 percent of the population get to eat eggs, fish, chicken or other
meats.
In the adivasi (scheduled tribe) population, 53.9 percent of children have stunted growth while
54.5 percent of adivasi children and 47.9 percent of dalit (scheduled castes) children are
underweight for their age.
We encounter another contradiction here. When the government seeks to define a measure of
poverty under these circumstances, its inclination is to ensure it is accountable to as low a
percentage of the population as possible. Poverty has been defined using the per capita
expenditure and consumption in the decade of the 1970s as a base. Which means the
calculation is based on fixed prices of items of consumption instead of their current values.
Our economist prime minister declared in a public forum in January 2012 that malnutrition is a
national shame. At around the same time the countrys Planning Commission came out with
its latest statistical assessment of poverty in India, which showed that the population living
under the poverty line had declined to 29.7 percent from 37.2 percent. The calculation was
based on the per capita expenditure.
According to the Planning Commission, a family living on a daily income of less than Rs22.42 per
capita in rural areas and Rs28.65 per capita in urban areas could be categorized as being below
the poverty line. This sum covers expenditure on education, health, social communication,
transport, food, leisure and intoxicating substances (alcohol, tobacco, etc).
These paltry sums raise serious questions about the intentions of the state. At current prices
wheat costs Rs15 per kg, rice Rs20 and pulses anywhere from Rs50 to Rs70, and public
transport Rs1 to Rs3 per km. Fixing the poverty line at such an absurdly low level shows that
over 75 percent of the population are nowhere in focus in the developmental concerns of the
state.
When the country gained independence in 1947, the Indian people visualized the state as
playing the role of a guardian looking after the interests of society. This idealistic belief saw the
state progressively gaining ascendancy over society and abrogating its responsibilities by
fashioning policies to hand them over to other socio-economic structures.
Society believed the state would be accountable and the people would remain its central
concern. The deprived sections would receive special attention and protection to ensure that
inequality, exploitation and discrimination are eradicated.
Instead, modern concepts of development have seen the private sector, once protected by the
state, emerging as such a powerful force that even the state finds difficult to control and rein
in.

The question of health services and their organization

All health and nutrition indicators in India are dismal even today. We have more or less lost all
faith in democratic development touching the lives of all the people. The sole concern of the
state is to look for ways to achieve greater economic development. But the policies it adopts do
not ensure that everyone has equal opportunity and access to the fruits of economic
development.
We are committing all our national resources into the hands of a particular social class. The rich
get richer and the poor poorer.
Another new class is emerging in the shadow of the rich. It is a class born to fulfil the role of
able and wealthy slaves of the rich. It is not expected to ponder the role it plays or the
consequences of its contributions. It does not concern itself with the fact that the indulgences it
enjoys cloak an insidious process of looting that is taking place on a national scale.
Behind this new middle class of the emerging capitalist order stands the forgotten class. It is a
class faced with the bitter everyday reality of wondering whether it will get work for the day
and whether it will be able to meet its daily bodily needs. It is a class that dreams at night that
its young ones are sleeping on a full stomach and get proper medical care when they fall ill. It is
not a dead class but one that has returned alive from the ravages of malaria.
Between its battles each day and its dreams at night lies a vast chasm. In India, that chasm is
called development.
The circumstances we find ourselves in today embolden us to open this can of worms to
understand the underlying reality. For us, malnutrition and health are not separate concepts.
We have sought to analyse their close inter-relationship in a social and political perspective. So
while this paper discusses the two issues it is clear the discussion is not in separate sections.
Where are our policies leading us?
We need to first talk about some important aspects without which anything that follows would
remain incomplete. Begin with the Indian Constitution. It defines human rights in two distinct
categories. One category includes fundamental rights, which are inalienable political rights of
citizens that the state is duty bound to protect and implement and include the right to life.
The second category includes social and economic rights that form part of the Directive
Principles of State Policy. The state can formulate policies governing these rights but is not
obligated to ensure their implementation. The right to health and nutrition fall in this category,
as does the right to maternal health and protection.
Peoples campaigns in India are posited on the argument that the right to life cannot be
guaranteed without the right to health and nutrition. The state only formulates policies but
stops short of implementing them.
The Planning Commission set up Expert Groups to advise it on the perspective that needs to be
adopted in different development areas and on different developmental issues for the Twelfth
Five-Year Plan (2012-17). The Expert Group on Health recommended that the objective should
be to set up a strong, universal healthcare system to reach health services to the people,
control diseases and propagate preventive health measures.
The experts pointed out that 80 percent of health services for out-patient care in the country
are in the private sector, while 60 percent of the population goes to private sector hospitals for
in-patient care. People also pay 79 percent of their health expenditure from their own pockets.
More distressing, 68 percent cannot access private healthcare services because they cannot
afford to pay the fees or buy the required medicines.
The expenditure on health averages 4.5 percent of Gross Domestic Product (GDP) but the state
contributes only 1.5 percent of this amount. Even more unbelievable is the fact that its
contribution to expenditure on medicines is an abysmal 0.1 percent of GDP. It is also common
knowledge that there is a serious paucity of medicines in the public health services and people
do not get the medicines they require.
The Expert Group on Infectious and Non-infectious Diseases points out that no initiatives are
being taken to prevent the spread of disease and it is only in the event of an epidemic that
some activity is seen in the health system, by which time it is generally too late to take effective
counter- measures. Little wonder then that number of epidemic break-outs rose from 553 in
2008 to 990 in 2010.
What is disturbing is that new forms of disease such as falciparum malaria - are emerging and,
apart from infectious outbreaks, the incidence of permanent illnesses such as heart disease and
diabetes is assuming epidemic proportions. The Planning Commission has done nothing to
investigate why these diseases are spreading and why people are becoming more susceptible to
them.
Health insurance has not proven to be a successful strategy for healthcare. It can be viable only
if the premiums are within the economic reach of people. This can only become possible if the
cost of treatment comes down. But the health sector has become a profit centre in India today.
Health services are among the costliest services in the country.
The health insurance sector is also guilty of short changing the people. Instances of the
medically insured not getting the promised treatment abound. There is corruption at every
level in the claims process. First, it is difficult to get the benefits and even when the benefits are
available the insurance agent claims a share of the amount disbursed. As a result, people tend
to exaggerate their claims, knowing that a portion will be expropriated, and this is how the
system breaks down.
It is not easy to benefit from an insurance system in India. A perusal of the insurance
documents reveals that there are nine points relating to instances where the benefits can be
availed of and 33 points of instances where no benefits are forthcoming. The truth is that
making treatment services available is not the priority of the insurance market. The procedures
are so involved and complicated and the premiums so high that medical insurance is impossible
for most people, especially in rural areas.
It shouldnt therefore come as a surprise that infant mortality doesnt come within the purview
of medical insurance even though 54 percent of child mortality relate to deaths of newborns
aged under 28 days.
It is a well known fact that most deaths from illness occur because people have no resources to
access treatment. Is this not a clear violation of their right to live? In the state where I live, raids
on senior officials of the Health Department, conducted between 2009 and 2012, led to the
seizure of property worth Rs2.8 billion. Similar seizures from officials responsible for child
nutrition programmes amounted to Rs3 billion. But these raids did not lead to any punitive
actions.
Madhya Pradesh has sanctioned the appointment of 6,000 doctors in its health services. Of
these, 2,200 posts (36.6 percent) remain vacant. The biggest irony is that this is the state that
has the highest reported number of maternal and child deaths. Over the past six years, the
annual growth rate of such deaths has increased from 7 percent to 11 percent.
A perusal of government expenditure on childrens health reveals some astounding statistics.
Expenditure on each child averages Rs52 in a year. Madhya Pradesh claims that it has achieved
the millennium goal of ensuring that 90 percent of all cases of childbirth in the state (around
1.5 million) are institutional deliveries. But who is delivering these babies when 345 out of the
636 sanctioned posts of womens health specialists (54.2 percent) and 250 out of 573 posts of
child health specialists (43.6 percent) and 148 out of 308 posts of anaesthetists (48.1 percent)
lie vacant?
Medical education is a profitable trade in India. This sector has also seen rampant privatization
and anyone seeking a medical degree has to spend anywhere between Rs3-to-5 million, with
postgraduate qualifications requiring another Rs3-to-12 million. That precludes medical
graduates joining the government health systems.
India has the Indian Medical Council (IMC) to oversee the privatization of medical education.
The chief official of this body was found to be demanding Rs10-to-15 million of candidates
seeking a seat in these private medical colleges.
Health services have not been recognized as a human right in India. If such recognition is
forthcoming one can expect a qualitative change in the government health system and
accountability becoming a constitutional requirement in the private sector. Whoever provides
the service, it must be ensured that if a person dies he may die as a result of the gravity of the
illness but not because of a lack of health services and medicines or corruption and negligence
in treatment.

These are the real conditions

What are the eternal and practical aspects of health and nutrition? The bitter truth is that
people seldom figure in the equation when the ideological framework of a healthcare system is
visualized. Policy makers never seem to consider the question of whether health services
should reach the people or whether people should reach the health services. Primary
healthcare is a shambles while specialist care remains a distant dream for the people.
We cannot analyse the right to healthcare by remaining neutral. We need to take a stand. The
stand must be that of the deprived sections of society, women, children, the differently abled,
dalits and adivasis.
In Madhya Pradesh, there is a district called Shivpuri. It is largely peopled by the Sahariya
community, a primitive, backward tribe. The tale of two villages in the district clearly illustrates
how the right to health and nutrition can be bypassed in a welfare state. Kakra village, situated
about 8km on the road from Pohri development block, has 45 children aged below six years.
On a recent visit to this village, I found many children cracking the hard kernel of a berry-like
fruit to get to its tiny seed, which they promptly ate. The adivasi community collects and
consumes various kinds of fruits and tubers from the forests. I too sat with the children to eat
the seeds. I asked one of them where they got the kernels. He pointed to a nearby mound of
dung and told me the cattle eat a fruit in the forest and the kernel is defecated with their dung.
I was taken aback. Wouldnt you? They told me the fruit is called ghotha or ghothi.
I then visited a few houses in the village to talk to the people. Every house had about 10-to-
20kg of wheat. There was nothing else apart from the wheat. Absolutely nothing! The wheat
was there only because they got wheat through the public distribution system. There was not a
single house where pulses had been cooked any time over the past 20 days. Small children sat
in the laps of their mother or grandmother munching dry rotis (flat wheat bread).
The concept of nutrition seemed nowhere in evidence in a place like this. For drinking water,
the villagers crossed the road, descended 600 metres downhill to where two hand-pumps had
been installed. This was their only source of water. The village did not have a single water tank.
For health services, the expenditure on medicines alone is Rs40.59 (3.58%) in villages and
Rs62.05 (3.12%) in cities. Now witness the range of inequality the expenditure on medicines is
Rs125.63 in Kerala, Rs108.49 in Goa and Rs110.71 in Puducherry while it is Rs33.98 in Sikkim
and Jharkhand, Rs29.25 in Assam and Rs40.98 in Bihar. This picture leaves no room for doubt
that the states priorities are to formulate policies that help establish an open market in the
food, education and health sectors. Indias Constitution unequivocally states that the peoples
right to life is a fundamental right.
These three services are an inalienable part of our fundamental rights, a fact that has been
repeatedly stated by the Supreme Court and also clearly enunciated by our Parliament. People
spend 55-to-60 percent of their income on food but still do not get the minimum levels of
nutrition specified in National Institute of Nutrition standards. According to the Planning
Commission the largest expenditure is on health related needs. Because they cant get loans
from institutional sources they approach local moneylenders who proffer loans at annual
interest rates that can range from 36 percent to as high as 120 percent.
India has the largest number of children dying before they celebrate their first birthday. It also
has the largest number of maternal deaths. Half the worlds lepers (130,000) and 21 percent of
tuberculosis affected (1.9 million) are to be found in the country.
In 2011, the per capita expenditure on health was around Rs2,500. Of this, the government
contributed Rs675 through its health services, the remaining Rs1,825 coming from the pockets
of the people. Loans taken to meet medical expenses are the single biggest cause of indebtness
in the country.
In 2011, the per capita expenditure on medicines was just Rs43. Of this, only 5.4 percent was
distributed free.
India needs 2.47 million doctors, nurses, and health workers to strengthen its healthcare
system. If the planned infrastructure is put in place, 6,26,000 doctors and 4.97 million health
workers would be needed. The health budget clearly shows how serious the government is
about its commitment to peoples right to health. According to a Planning Commission report,
the country needs 187 more medical colleges, 383 nursing schools and 232 ANM schools to
fulfill the countrys requirements. But there is no sign of any inclination to set up this
infrastructure.

The challenges facing maternal and child care

Madhya Pradesh faces many challenges in providing maternal and child care services. The Rural
Health Mission and the Reproductive Health Programme are attempts to bring some
improvements and reforms in the healthcare system.
Health in India is not defined in any law since the government is not constitutionally bound to
observe health as a fundamental right. Instead, healthcare is explained and implemented
through missions and plans. The prime national objective in healthcare is to achieve the UNs
Millennium Development Goals. But the state has not taken up any national campaign to
reform and strengthen the condition of the existing healthcare system.
The government has set a goal of 100 percent institutional births because some studies may
have shown that this target may be achievable.
In Madhya Pradesh, 89 percent of births occurred in hospitals in 2011-12, against 26 percent in
2006. How believable is this statistic in a state that has one hospital bed for every 2,300
people? If the situation in villages is considered, the average is one hospital bed for every 5,000
people. The closest health centre for a pregnant woman to have a safe delivery is, on average,
situated 30km away. Getting transport to reach the centre is still a big challenge.
Madhya Pradesh is one of Indias largest states with a population of 72.5 million. Over the past
five years it has registered around 1.65 million births. When we say that institutional childbirth
should be the norm in such a state it is first essential to analyze the state of its healthcare
infrastructure. The state has sanctioned the appointment of 662 womens health specialists but
339 of these sanctioned posts (53.6 percent) lie vacant. This is a contradiction. When we talk
about healthcare within easy reach of people we find that the community health centre (meant
to cater to a population of 30,000 people) has 281 of its 334 sanctioned posts of womens
health specialists (84.13 percent) lying vacant.
There is no constitutional or legal mechanism to ensure that doctors compulsorily serve in rural
areas and, more especially, in the difficult-to-reach hinterland. An study of government data on
institutional births done by Vikas Samwad reveals that there were 1.21 such births reported in
2010-11, which means every doctor was expected to attend to an average of 1,823 deliveries -
with one specialist reported to have attended to 4,119 childbirths.
Is this an ideal situation to guarantee maternal health and safety? Taking our analysis further,
National Health System Resource Centre statistics show that Madhya Pradesh witnessed 719
maternal deaths during 2010-11, of which the cause of death was stated as unknown in 51
percent of the cases. Another fact that emerged was that the maternal mortality rate is 269 per
1,000 live births, which means there were 4,400 maternal deaths in that year in the state. That
points to only 17 percent of the deaths occurring within the institutional care system.
Gender discrimination is another big challenge in maternal health. Women are not free to
choose nor are they treated as equals so that limits their right to health as well. Our society is
reluctant to even discuss the issue of womens health. The family priority is to hide whatever is
happening when girls reach puberty and experience the physical and mental changes taking
place.
When it comes to the question of nutrition, women are not seen as contributors to family
income, which limits their claim to health and nutrition. This is why the main causes of maternal
deaths are malnutrition, anaemia, stress and excessive bleeding.
India had a National Maternal Assistance Plan under which pregnant women below the poverty
line are entitled to a one-time payment of Rs500 two to three months before their delivery to
enable them to get the required nutrition and medicines. Keeping in mind the social realities,
the government shut the programme down in 2001-08 and launched a new initiative
Womens Protection Plan in which any pregnant woman who delivered her child in the health
centre could claim a one-time payment of Rs1,400.
Shutting down a programme that promised pre-delivery nutritional assistance in a situation of
gender inequality and encouraging institutional deliveries when the healthcare system is in
disarray and transport is unavailable is a double blow for women. It is obvious that the thrust of
the new programme is to encourage institutional deliveries to reach the mandated targets.
There is also another hidden agenda sterilization. It is part of the package for women coming
to health centres for delivery.
Now consider another fact. Given their social status, women have to constantly confront male
violence and demands for dowry. In this scenario, the Madhya Pradesh government has
launched a Kanyadaan Plan under which women are given a sum of Rs15,000 to celebrate a
traditional dowry based marriage. Not just this, everything, every symbol that is used
perpetuates this system of bondage.
We may have brought some technical improvements into the healthcare system but similar
initiatives on the social and political front are conspicuous by their absence.
When we talk about childrens right to life, we accept that life begins when fertilization takes
place in the womb. It is clear in the present scenario that inadequate attention has been paid to
adapting the healthcare system to focus on the needs of women and children. The states
primary healthcare system is in a shambles and requires to be reformed.
Madhya Pradesh has 20 million children aged below 12 years. Yet of the sanctioned posts of
572 child health specialists 250 posts (43.7 percent) lie vacant. According to the National Health
System Resources Centre, 11,610 child deaths were reported in 2010-11 of which the cause of
death was stated as unknown in 8,356 cases (75percent).
The weaknesses of the system affect children as much as it does women. According to the
mortality rate of children aged below five years a total of 160,000 deaths occur every year but
only 16,110 child deaths were reported. This statistic shows the healthcare system is not
reaching the people it is supposed to cater to.
One positive development that requires mention is the initiative undertaken by the Madhya
Pradesh government in 2009 to establish intensive care units for newborns in all district
hospitals. This should be seen as an important step because 50 percent of newborn deaths
occur within 28 days of birth. A large percentage of families cannot afford medical treatment of
the newborn because it is expensive.
If economic development is the focus of the state in the present times then society should also
accord priority to healthcare because it is only healthy and well nourished people who can
positively contribute to economic and social development.

The truth about the nutrition programme

In the human species, 90 percent of physical and mental growth occurs in the first five years of
life. So children aged below five years need to be assured food and nutrition security if they are
to achieve normal physiological and mental growth and not suffer the deleterious impact of
malnutrition and stunted growth. The government launched an Integrated Child Development
Scheme (ICDS) in 1975 to combat the scourge of malnutrition. The worlds largest universal
nutrition and childcare programme sought to ensure that children received adequate nutrition
by reaching healthcare services to the community.
One cannot address child health and nutrition issues without simultaneously taking into
account the health and nutrition status of women. So the ICDS took a holistic approach by
factoring in nutrition schemes for pregnant and nursing mothers, pre- and post-natal medical
investigations and vaccination. An analysis of the situation prevailing 37 years ago had shown
that children faced a 300-to-500 calorie and 8-to-12 gm protein deficit in their diet, which the
ICDS sought to bridge.
But the scheme never figured high in the priorities of the state. Children do not constitute vote
banks. Also, with privatization and revenue generation concerns coming into focus under the
market oriented reform policies of the 1990s, resource and infrastructure investment also
tended to peter out.
In 2001, the Peoples Union for Civil Liberties (PUCL), a civil society group, filed a public-interest
litigation (PIL) in the Supreme Court of India questioning the role of the state in ensuring food
security for the people and preventing starvation deaths. The PIL took the cloak off a bitter
truth that starvation was an integral part of the lives of children, widowed women, the aged,
the differently abled, primitive tribes and some other sections of our society that have
historically faced the deleterious impacts of social discrimination.
An analysis of the ICDS reveals that until 2004 not more than 35 percent of the target children
had been covered by this universal nutrition and healthcare scheme. Among these, only 25
percent benefited from the services rendered under the scheme. A closer look brings out the
fact that the budget allocations were also contradiction-ridden and often without logic. During
the period that the wages of government employees rose 100 percent (1991 to 2005) the daily
allocation for nutritious food per child under the ICDS remained a dismal Re1. That adds up to
0.7 percent of the budget being allocated to a segment that constitutes 17 percent of our
population.
A government order of 2009 reveals that the energy deficit in childrens diets is far higher than
assessed earlier, and were actually in the region of 500-to-1,000 calories. The protein deficit
was also shown to be significantly higher.
Our estimates show us that at the current child mortality rate of 64 per 1,000 live births, every
year 1.47 million children aged below five years succumb. Malnutrition is a major cause of
death in 1.1 million cases.

The poverty line

In India, the poverty line is determined on the basis of calorie intake. Around 36 percent of the
population was enumerated as being below the poverty line in 1997. This figure declined by 10
percent to 26 percent in 2002. Therein lies a tale.
In 1997, the government lowered the daily calorie intake standard it had fixed for drawing the
poverty line. The ostensible reason given was for better targeting of anti-poverty programmes
to the neediest but an alternative explanation could be that it wanted to show a significant
decline in poverty in the country.
This poverty estimation was challenged in the Supreme Court by the Right to Food Campaign, a
civil society group, in 2002. This forced the government to accept in 2006 that poverty had not
declined and the percentage below the poverty line continued to be 36 percent.\
In 2010, the government issued a fresh poverty estimate 32 percent below the poverty line.
This estimate was also strongly opposed by civil society groups. Their argument remained
unchanged. They pointed out that the malnutrition percentage had not fallen and starvation
was on the increase with food-grain prices rising 80 percent. Moreover, 45 million people were
looking for employment in a situation where jobs are available for only 2 million people. So by
what magic wave of the wand had poverty declined in such a scenario?
Ironically, it was the report of another government agency that conducts periodical
consumption expenditure surveys and puts out figures on the per capita calorie intake of Indian
households that raises doubts about the government claim. The National Sample Survey
Organisation (NSSO) pointed out in its Nutritional Intake in India 2012reportthat 80 percent of
the countrys population did not get adequate nutrition (in particular the minimum standard
calorie intake).
Today, the Planning Commission says 29.7 percent of the Indian people live in poverty when
the reality is that 80 percent do not have food in the proper nutritive measure. This means
more than 50 percent of the population, which does not get adequate nourishment, is
considered to be above the poverty line. So the government does not extend them the right to
receive cheap food and subsidized food-grain, health services and social security. In terms of
numbers, this 50 percent adds up to 610 million people, which includes 84 million children, who
are being pushed to the margins. Can we ever hope to be free of the scourge of malnutrition in
these circumstances?

Have we really become self-reliant or have we just reconciled

ourselves to starvation?
According to the governments Expert Group, people living in rural India require 2,400 calories
of energy to fulfil their daily needs while those living in cities require 2,100 calories. In 1972-73
rural people obtained 2,266 calories of energy from the food they ate, the figure for urban
areas being 2.107 calories. In 2009-10, this availability had dipped to 2,020 calories in rural
areas and 1,946 calories in urban areas.
Protein availability has also shown a similar decline during this period, falling from 60.2gm per
capita to 55gm in rural areas and from 57.2gm to 53.5gm in urban areas.
Our demand is that given the current gravity of the situation, the government raises the daily
per capita expenditure on children from the present Rs8 to a minimum of Rs25. This would
require a budgetary allocation of Rs1.35 trillion. Is this not a stark contradiction that the nation
sees its children in distress but is unwilling to allocate this money on the plea of a paucity of
resources yet grants income tax, export-import tax and trading fee concessions totalling Rs27
trillion to corporate entities between 2006 and 2011 in the name of catalyzing economic
growth. These concessions cover automobile production, jewellery exports and 5- and 10-year
tax holidays for industries.
Despite its huge need for financial resources, the ratio of resources raised through taxation is
very low only 10.5 percent of GDP is generated through tax revenues.

The perspective of the state

The chapter in the Indian governments annual Economic Survey that is linked to our concerns
is titled Agriculture and Food Management. Consider the difference between food
management and food security. The 2010-11 Economic Survey points out that the green
revolution of the 1960s ushered in a sea change in agricultural production and productivity.
But pulses, oilseeds, fruits and vegetables were overlooked in this initial research and planning
thrust. From the nutrition viewpoint, it was important to have focused on these crops as well.
We now plan to make good this shortcoming through a second green revolution. But the
government accepts the fact that even if production increases, the distribution system is so
inadequate that such nutritive foodstuff cannot be reached to the people.
The government now at least accepts that wheat and rice alone cannot guarantee food
security. But the reality is that these two cereals constitute 78 percent of Indias total food-
grain production. Other grains are slowly becoming extinct.
We also see that the minimum support prices the government announces for different food-
grains are usually well below their actual production costs. When the government offered a
minimum support price of Rs1,000 for a quintal (100kg) of wheat, the cost of production was
Rs1,543.93 (Economic Survey 2010-11).
In January 2010 the governments procurement target for food-grains for the public distribution
system was 25 million tonnes. The actual procurement was 47.4 million tonnes. In October
2010 the target was 21.2 million tonnes but 46.2 million tonnes were piled up in warehouses
and temporary shelters. This year government purchases were completed in June. It is
estimated that 75 million tonnes are currently being stored. Over the past four years 5 million
tonnes of food-grain have rotted in storage.
The Supreme Court has observed that given the present situation of large-scale starvation the
food-grain must not be left to rot but distributed among the poor. But our prime minister, who
has termed malnutrition as a national shame has told the court that the grain cannot be
distributed because it is a policy issue (indirectly telling the court not to interfere and give an
order on the issue). Even today food-grain rots in open storage because our procurement,
warehousing and distribution systems are highly centralized.
It is true that malnutrition has become a national issue and there is a lot of activity going on at
the policy level. But much of the debate centres around the creation of facilities/infrastructure
and institution-based management. Gaining currency is the view that some special micro-
nutrient enriched products should be incorporated into the management of malnutrition and
the language in use today includes examples such as ready-to-use therapeutics, ready-to-use
food and energy-dense food.
We feel that the most appropriate management, treatment and prevention of malnutrition can
only be done at the community level. As responsible civil society and citizens groups we have
been fighting for the adoption of such a community-based management approach at the policy
level.
At the same time, some international funding and health agencies are trying to convince the
government that malnutrition can be eradicated with a handful of special products. We talk of
peoples rights. They try to establish the charity perspective of serving the people. The reality
that faces us is that according priority to factory produced goods and market forces will
influence and disrupt community responses and behaviour as well as traditional household
food security practices. Such a system cannot serve the needs of Indias poor classes and will
prove ineffectual for people whose lives are based on sustainable use of natural resources. The
cycle of malnutrition begins when we seize these natural resources from their traditional
control and management.
There are many problems connected with implementing such a programme and some serious
policy weaknesses. But if some systemic changes are made on the basis of our experience till
now then Indias present programme to combat malnutrition could be successful to some
extent. At another level we need to give implement ideas such as gaining control over
production and resources, afford state protection to agriculture, and ensure that food security
is kept out of the purview of the private sector all of which are the basic causes of
malnutrition and starvation.
We believe that nutrition, food security, education, health and livelihood should be excluded
from the purview of the poverty line. This would be a first step in the direction of making these
rights inclusive and universally available. Without such inclusion development will remain an
empty word.

The role of the state and the community

The community should give shape to its food security system on the basis of its ecology,
environment and available resources. Food security is not limited to procuring food-grain. What
is important that every individual and community gets food and nutrition according to its needs
and in consonance with its culture. To achieve such a situation, providing the resources to
ensure the means of livelihood is important.
The requirements for ensuring food security change with changing circumstances and food
security means different things to different target groups. For infants aged below six months
food security means being breastfed by their mothers. Between the ages of six months and two
years, infants should have food that is easy to eat and digest. It should be soft and semi liquid,
yet contain the required nutritive elements. People performing hard physical labour should get
at least 50 percent more food and nutritive elements than those not doing hard physical labour.
The needs of the elderly also changes. For those suffering from tuberculosis, cancer and HIV
food security is not limited to providing adequate food and nutrition. It is important that the
medications they receive should be efficacious and made available consistently and they should
get food at the proper time. If they do not get the proper nourishment, the effect of
medications get diminished.
The state plays the role of an active participant in this process. It is its constitutional role to
ensure that no individual goes hungry because everyone has a fundamental right to enjoy a
happy and respectable life. The right to food means that the state should ensure that no one
remains hungry. For this it should formulate the appropriate laws and policies for production,
procurement, warehousing and distribution of food to ensure social justice for the people.
In these circumstances we need to strengthen the framework of our primary healthcare system
and ensure that adequate numbers of health personnel are duly appointed to run the system
efficiently. Health services should be reached to inaccessible regions and the district level
infrastructure should be strengthened, while specialist services should also be developed. Until
and unless we have a carefully monitored system that is answerable for its actions and there is
an effective complaint redressal mechanism people will not receive proper healthcare services.
At the policy level, the priority in health and nutrition should not be limited to merely initiating
schemes.

And a final word

Today, hunger and food security is a major political and social issue. The state is in the process
of passing a Food Security Act but this legislation is limited to providing those people living
below the poverty line with a fixed amount of cereal. It stops short of defining nutrition as a
basic right. Thats why it contains no mention of providing pulses, oilseeds and other foodstuff.
This means that the state is not recognizing or attacking the root causes of malnutrition, which
is an endemic condition linked to deprivation, poverty, new policies governing food security,
exclusion and plunder of resources. Our society cannot remain neutral to the economic and
political challenges thrown up by the crisis of malnutrition and food insecurity, which
exacerbates the crisis children face. If the outcome of our policies is widespread hunger and
starvation, the first to suffer the consequences are the children. Hunger first sinks its teeth into
and feasts upon the most vulnerable section of our society.
 A Corpse of Rights without Justice at its Soul

Do rights make any sense without justice? Can we expect that human rights will be
guaranteed without justice? Can we afford to seek justice only through the courts,
exempting the executive? The rule of law is not the state generating fear about its
might and ruling by it. What we have in India are rules and laws that could exploit the
marginalized.

One of the sad truths that we have to live with today is that the peoples struggles for human
rights are highly fragmented in India. Equally disheartening is the fact that whenever or
wherever human rights comes up for discussion, it is addressed in piecemeal, ignoring and
leaving far behind a comprehensive approach to rights based on the notion of justice. The focus
is usually on the concept of rights understood within the limited periphery of peoples welfare
in which quotient of justice is forgotten.
In India we have 713 legislations that deal with peoples rights, their entitlements and
protection. Another 19 on food, nutrition and health are on the anvil. In fact what we have is a
law-making regime for last 65 years, and the concept of justice is missing in the country.
Do rights make any sense without justice? Can we expect that human rights will be guaranteed
without justice? Can we afford to seek justice only through the courts, exempting the
executive? The rule of law is not the state generating fear about its might and ruling by it. What
we have in India are rules and laws that could exploit the marginalized.
When public pressure concerning an issue disturbs the state, the state comes out with a policy
and passes a law. But laws are meaningless if there is no system to implement them. And where
there is no accountability within the system legislating becomes a farcical exercise. The basic
objective of the peoples struggles in the country is to ensure proper implementation of the
laws. What we need to do is to think where and how deep is the passive or sometimes active
negations of rights permissible within the system. Otherwise the enormous efforts of the
peoples struggle to claim these rights would go in vain.
There are more than 3,000 struggles for justice going on in the countrys 640 thousand villages
where over 3500 thousand voluntary and non-governmental organizations work. This is ironic,
because India has some of the most progressive laws in the world and claims to be the worlds
largest functioning democracy. Yet it is a country in which 9,000 custodial deaths take place
every year and over 1500 thousand children die of malnutrition, while policymaking continues
unmindfully!
In such a situation how can we ignore the question of why the system refuses to change? Why
the lives of people count for nothing and why their standard of living shows little sign of
improvement?
There are 15,777 under trail prisoners in Madhya Pradesh and 15,784 in Maharashtra. They are
not considered eligible for bail, and are forced to wait for a final verdict till an uncertain time.
Many among them have already spent more time in the prison than what the sentences for the
crimes alleged against them might warrant. The path of justice tends to veer towards injustice
because the state, which has the responsibility to dispense justice, is not accountable to the
people. Is this, perhaps, part of its well thought out strategy to retain states supremacy over
the society? Its a thought worth considering.
The first question we need to ask ourselves is: what are the tribulations in our society and what
kind of change does we necessitate deciphering them? We are living in a period of policy
changes and laws. The government formulates policies and passes laws, allegedly to solve these
problems. But the laws remain on paper. They are of use to the society only if an institutional
framework for implementing them is created, an adequate budget sanctioned, officers
appointed, and other necessary infrastructure put in place.
For instance, the government claims that the people have a right to health. But if there are no
doctors, no hospitals, no money to buy medicines, what does this right mean? When will
people enjoy its benefits? The government has also passed a law giving people the right to free
and compulsory education. But to ensure quality and equal education to all we need enough
teachers, introduce new teaching methodologies and provide classrooms and toilets in schools.
But the financial resources available for this are not even half of what is in fact required. So
what kind of right to quality education could our children hope for or lay claim to?
Justice must be evident and should appear to be done. Rights cannot be seen as disconnected
from justice. If the state is unjust, if it abdicates its responsibility to dispense justice, people can
neither claim nor protect their rights. In India, the state is only putting on an act with its
people-oriented policies and laws to hoodwink the people. The reality is the continuing
violation of all basic rights. Nowhere in the laws is there a provision that says the government
will have zero tolerance for compromise and will take steps to ensure that people get not just
their rights but justice as well.
Take the example of the law guaranteeing the Right to Information (RTI Act 2005). It says if
people are denied this right the responsible official will be penalized to ensure that such
violations do not occur in future. The right is for seeking and obtaining information, but justice
is for taking actions to punish those officials who violate the right. As long as this aspect is
ignored, talking about rights is mere deception.
Justice and rights are not limited to the judiciary or to the state that is supposed to safeguard
them for society. They go beyond these institutions. Justice is a universal trait, a basic human
character, like courage, equality and respect for nature. It is not something that one obtains
only through a court of law. The notion of justice starts with the faith that justice will not be
denied. Justice is also the belief that when the authorities and the system where you go to
claim your rights will respect these rights and treat you in a way that raises your morale and
reinforces your belief in the system.
The search for justice could begin for instance with the police inspector or a constable in a
police station. If they are unjust, one cannot get justice from the court that in a criminal case
will have to depend upon the police for investigation of a criminal charge. The decision of the
court is based on the case report the police present. That is why justice is not something that
only a court of law ensures.
There is also the country's media that presents a case before the public. If the media is unjust,
they cannot feel the soreness that a victim experiences when rights are violated. Investigations
about rights violations without a perspective of justice serve only the purpose of whitewashing
of some and slinging mud at some others.
If more and more cases of rights violation keep occurring, and if they continue to be viewed in a
perspective devoid of justice, the policies that are eventually formulated will also be devoid of
justice. If justice is not ingrained into the system, it will become a purveyor of injustice. There
are no half measures, or middle path. You either have justice or injustice, corruption or
transparency. It is a shame to say that 40 percent justice is dispensed or 60 percent of the
system is corrupt. A system can be either completely just or absolutely unjust. It is a dangerous
reasoning for the future of democracy, society and the constitution to claim that the District
Collector is an honest person but the subordinate officers are corrupt, or the chief minister is
honest but his ministers are corrupt, or the prime minister is a good man but his cabinet
colleagues are bad.
The British ruled our country - India for more than 200 years as a colony. They came for
business and later continued to influence our systems - political, economic and social. They also
make laws and created institutions. Definitely those were not for the welfare of the people and
to ensure justice. They made it; to control any action, which might challenge their rule here in
any form. They forced people not to speak, they created police in 1861, and they made forest a
state property by creating the forest department in 1861 - 62, with a clear message that
community has no ownership over their natural resources; and suddenly with the creation of a
law and system, people become encroachers from the owners.
The colonization reduced the space for the people up to a level, where they found themselves
unable to breath. The colonial rulers follows a specific meaning of the rule of law; which for
them translates as regime to establish the rule of the state over the native society, to suppress
the strength of people, so that there is no opposition to the colonial interests. One country
rules the other for looting, not for welfare; so one cannot expect that the colonizer will take any
pain for setting up standards of living, welfare or norms for human rights. In such a situation
ruler (not the state per say) is the key culprit in human rights violations. And justice here means
protection to a section of people who provides them support for ruling their own country or
society.
The British hanged Indians who demanded justice, dignity, rights and freedom. They did follow
a system of judiciary - which was created to hang such people, who challenged the then state;
without considering the norms of justice or that of rights. At that moment justice translated as
the protection of those who were fighting for the countrys freedom. Tax and revenue systems
were made for looting resources; education system was contaminated to create a bonded
society. There should be no revolt even after extreme injustices like massive food shortages.
This was the key objective of the colonizer and that is why the concept of law and order
become important for them. We, in the independent state, continue to follow the same. If you
go for an agitation, you will be booked and may be disappeared forever. Why there is no scope
and space for those in the country who want to share their anger, frustration and agony; why
they are treated as criminals? Such space was not there before 1947 and still not there, 65
years since.
Making laws is a collective process of the legislature. The government drafts a bill and presents
it to the parliament. The bill is normally sent to the parliamentary standing committee, which
invites comments and suggestions from institutions/organizations and from the public. The bill
is accordingly modified and sent back to the parliament. But the government is not bound to
accept all the recommendations of the committee. So it is free to ignore any provisions that
may be mistakenly viewed as diluting the legislature's power or compromise its positions. The
passage of the bill depends on the strength of the ruling coalition. If it enjoys a majority in the
house it faces no compulsion to keep the people at the centre of its legislation.
A law is an all-encompassing document of the right in question. But often it does not outline
the steps required for its implementation or for creating the required institutional structure.
These are dealt with in the rules and procedures and this is where the next deception of the
people occurs. Unlike the bill, there is no scope for the standing committee to offer its views
and suggestions about the rules and procedures nor do people have the right to have their say.
There are enough loopholes and pitfalls in them for the people to stumble into and get trapped.
There are no systems to ensure that our rights are clothed in the cloak of justice.
The key to the implementation of a law is with the state. The 73rd Amendment of the
Constitution had paved the way for the decentralization of state power through the Panchayati
Raj, with authority given to the panchayats (elected local body at the cluster of villages) and
gram sabhas (village councils). But no panchayat can impede the salary of a corrupt official or
who do not perform his/her duty. It can only make recommendations to the executive that
action is to be taken against an erring officer. In the past, the village institutions controlled
resources but today these resources are retained in the central treasury by the state and the
panchayats and gram sabhas have to extend their palms to plead for central alms.
Our society is still ruled by the caste system; we all know this truth. It is plagued with
discrimination, gender inequality, un-touchability and feudalism, which is the reason why there
is little hope for the society or for its social institutions to make any real effort in creating a
system that is based on equality and social justice. Our society remains silent when confronted
by deaths from starvation and malnutrition. It fails to raise its collective voice against the rapes
that it witnesses. And instead of resisting the naked exploitation of our resources it spends its
energies looking for escape routes such as internal or external migration. It is in such situations
that the role of the state comes into focus.
The expectation is that the state will create a system to counter and abolish inequality,
discrimination, exploitation and social boycotts. Such a system cannot be limited to policy
formulation and law making. Laws create the system and the system should, in principle,
function within its ambit. Social contradictions can only be resolved by governance guided by
value and justice-based laws. In todays context, it means justice and values should remain not
just the responsibility of the state, but also that of its banks, media, markets, production
systems and in the private sector. Otherwise these agencies inevitably become the new players
in the processes of exploitation and subjugation.
Rights cannot be claimed or given unless and until an accountable and institutionalized
structure is created to implement them. The laws enacted should be such that they carry the
message of rights with justice. They should explicitly state that an institutionalized structure will
be set up for implementation, with an effective, transparent and decentralized mechanism to
monitor the implementation and register and resolve complaints within a specified time. They
should also contain provisions to punish the guilty and compensate the victims of rights
violations. Equally important is sanctioning of the required budget, because without such
allocations, nothing is possible.
Madhya Pradesh is a state where six million children are battling malnutrition. Their chances of
winning this battle are slim because the state government does not provide them the kind of
support they need. But eradicating malnutrition is a battle that the state should be fighting
because it is the constitutional guardian of our children. The Integrated Child Development
Scheme (ICDS) was formulated in 1975 to address and resolve the problem. Its primary target is
children aged below six years, who are most susceptible to malnutrition. But 37 years after its
launch, malnutrition remains a scourge that continues to play with the life of our children. The
question we need to ask is: Why did such an ambitious scheme fail to bring any significant
change in the situation?
The ICDS provides for setting up anganwadis (child development centre at the level of every
local habitation) to care for all children and the Supreme Court has decreed that such care
centers must be established in every village and habitation and no child should be denied its
services. The anganwadis have the infrastructure to provide six crucial services to children, at
least on paper. These include monitoring their growth and development, providing nutritious
food, imparting health and nutrition education to pregnant/lactating mothers as well as
adolescent girls, vaccinating children, imparting pre-school education and admitting the
seriously ill in hospitals.
An anganwadi has to cater the needs of around 40 children aged below six years, under the
supervision of an anganwadi worker and a helper, who are recruited from the village. The
worker has to maintain six registers with vital data about the children and the services
rendered. Can two workers cope with this large burden of responsibility? The Supreme Court
has instructed that the anganwadi services should be universalized and their quality should be
improved. The government continues to enrol children in the care centres but it has done very
little to increase human resources, their capacities, infrastructure facilities and remuneration.
In 1991, the government made an allocation of one rupee per child for providing nutritious
food. But the actual disbursal was Paisa 47 ($0.023) per child. If seen from another angle the
budgetary provisions would be adequate for only 47 percent of the child population in this age
group. Moreover, when the village community complains that nutritious food is not provided
for six months in an year, the bureaucracy did not point out that the allocation itself has been
drastically cut and that is why children remain hungry. Instead, it blames the anganwadi
workers and takes action against them to maintain the power of the state. Where can the
anganwadi workers go to fight for their rights and justice? There is no mechanism to give them
justice.
Another distressing fact is that the budgetary provision remained unchanged for 15 years until
2005, when it was raised to Rupees two per child. Today, in 2012, the amount is Rupees four
per child, which is still only half of the actual need. This is the irony. The government calls
malnutrition a national shame yet allocates a measly amount - which cannot even buy a cup of
tea in todays market price - to resolve the crisis. A country with one of the fastest growing
economies of the world has the largest population of malnourished children among all nations
and yet it has no willingness to give more than one percent of its budget for children aged
below six years, who constitute 14 percent of its population!
The ICDS has been riddled with corruption since the time it was launched. There is no
mechanism in the system to register complaints against this corruption, carryout an impartial
investigation, take immediate action, award punishment, or protect the rights of the children
and women. If a complaint is registered, the state government asks the district collector and
the programme head in the district to conduct an inquiry. These officials themselves are an
integral part of the implementing agencies. So in a way they are responsible for the corruption
and negligence. Should the accused be given the responsibility of investigating the
misdemeanor and felony?
Madhya Pradesh has constituted a State Commission for Protection of Childs Rights. To begin
with, it is a moribund organization. Even if any of its members take the initiative to fulfil its
responsibilities, there is little likelihood of anything coming out of the exercise because the
commission only has the power to make recommendations but not the power to ensure
compliance by the implementing agency, which has unlimited and unrestrained power. Perhaps
the government wants it this way. That is why it never acknowledges that the lack of
accountability.
The state does not appear committed to protect human rights or dispense justice. In such a
situation, children will continue to starve and be malnourished. Their hunger is not so much the
outcome of inadequate food but the lack of accountability, corruption, carelessness and
despicable apathy of the state.
It is a question of intent. On the one hand there is no system or mechanism to ensure justice,
while on the other our judicial system is caught up in protecting its own interests. In 2011, a
total of 26.3 million cases were pending in Indian courts. It would require 24 years for the
courts to clear the backlog, provided no new cases are registered in the interim. If cases
continue to be registered at the current rate, the courts would have a backlog of 240 million
pending cases.
This only shows that the state is becoming progressively ill equipped to deal with its
responsibilities even as its officials show an increasing tendency to abuse their authority. Even
then the government makes no commitment to overhaul the system to ensure that the people
do not have to wait endlessly for justice. People living in Manipur, Arunachal Pradesh, Nagaland
and Tripura have to travel all the way to the high court in Guwahati because there are no other
high courts in these northeastern states.
Take a look at the following example. In 2006, the Indian government passed a law recognizing
the forest rights of scheduled tribes and other traditional forest dwellers. The law declares in its
opening statement that the indigenous communities have been subjected to historical injustice
for centuries and the state seeks to give them justice through this legislation. Now take a look
at its provisions. In order to establish community rights to forests the villagers have to produce
adequate documentation to show that they have been using forests for their livelihood, grazing
and access or for cultural and religious purposes or for foraging forest produce for their daily
needs. This is a task that is beyond most of them.
In India, systematic records have been maintained at the district level (in district record room)
from even before 1950 of every village, its resources and their use. Many people are not even
aware of this storehouse of data and information. These documents are called nistar patrak
(record of use of land, forest and other natural resources) and Bajib-ul-Arz. It is almost
impossible for villagers to access these documents in the maze of modern bureaucracy and red
tape. The result is that only around five percent of the claims to community rights have been
legally established and recognized.
If the intent of the government is to confer community rights to the rightful claimants why did
it not add a provision to the law stating that it will make available all the documents in its
possession to the gram sabha and the village level forest rights committees to enable them to
process claims and establish the rights of the community? It is the responsibility of the
government to provide the required documentation, not of the people who have been
subjected to this historic injustice. Until and unless the state internalizes the concept of justice
every utterance of its officials will be futile and meaningless. But the state is reluctant to part
with the power it has over the people.
It is not as if the government has never built a strong institutional framework for implementing
its laws. Wherever it needs to protect its powers it ensures that such a system is established.
For example, when electricity production was privatized, private companies were permitted to
decide electricity tariffs, a job which the government did earlier. It set up an Electricity
Regulatory Commission to approve the tariff increases and give them the official stamp. The
commission gives priority to the arguments of the private companies, not the government or
the people, in arriving at its decisions. As a result, electricity tariffs have been raised by 20-30
percent every year.
Water is also in the process of being privatized and the appropriate institutional changes will be
affected. Poor people living in slums will now have no access to free water. Prices will be raised
periodically and those who cannot pay will be deprived of their right to water and electricity.
The government gives statutory powers to these commissions, which make them more
powerful than even the parliamentarians. This clearly shows that the implementation of a law
depends on the kind of enabling institutional structures that are created.
The problem is not that 42 percent of our children are victims of malnutrition or that our prime
minister calls this a national shame. The problem is that the state has made no concrete effort
to resolve the problem, nor created accountable and resource-rich institutions to deal with it.
Nor does the system have responsible people and policy makers or a planned mechanism to
implement a solution. The problem is that the bureaucracy is neither accountable nor capable
of dealing with the situation. Even if there are capable bureaucrats who do good work, they end
up being punished instead of rewarded because corruption is accepted as a way of life.
The problem is that the state has been given too much power and sees itself as supreme. It
understands strength and turns a blind eye to those pages in the constitution that elaborate its
duties and responsibilities. Its limited perspective tells it to silence and neutralize anyone who
dares to criticize its functioning. This is the reason why the state is very often seen to be
despotic in its work. It adopts every means to protect its powers, whether through the use of
the law and its policies or otherwise. We need to analyze these methods and counter such
despotism with democratic values.
We also need to understand the link between peoples struggles, agitation and advocacy.
Peoples struggles emerge in certain special circumstances and the initiatives they take aim to
change the mindset of society. They see the problem from a social and political perspective but
find themselves caught up in many dilemmas. They cannot decide how to change the system if
the very root of the crisis lies in its unjust nature. The system can only be changed by
democratic means, but there is a reluctance to enter into electoral politics to affect such
political change. The people find themselves caught up in answering the questions posed by the
government when in reality it is they who should be demanding answers from the government.
The peoples struggles have been weakened and divided by the state through its power to
distribute favours and services.
Prior to 1997, everyone could get ration through the public distribution system. In 1997 the
government decided to draw a poverty line and declared that only those below this line could
receive subsidized rations. The poverty line was a ruse to deny rations to 64 percent of the
population. And now when a peoples struggle is being fought to bring about institutional
change in the rationing system, our middle class and the class of people excluded from the
ambit of rations by the poverty line turn their faces on this struggle, saying they have nothing to
do with it. And those who are eligible for rations are so socially and economically debilitated
and deprived that they find it difficult to leave everything to fight for their rights.
The state weakens the peoples struggle for social, political and economic rights in this way. In
the past 20 years we have seen farmers and agricultural labour melded into a powerful force
but the state had created divisions between them through its policies. For example, it has
reduced the concessions and subsidies extended to agriculture, raising the cost of production.
At the same time, it has raised the wages of unskilled labour, who also work as farm labour,
through the National Rural Employment Guarantee Act.
The government has not given proper support prices for agricultural produce while it has given
a fillip to the import of cheaper agriculture products from other countries, where farmers are
given large subsidies. With cheap imports flooding the markets the local farmers have no
market for their produce. The outcome is that they are in a pitiable state today. Most of them
(77 percent) are small and medium farmers owning less than two hectares of cultivable land.
They find committing suicide to be an easier alternative than farming.
The growing urbanization of the country is also responsible for alienating society from the
concerns of our villages. The pitiable state of health and education services in rural areas and
the crisis caused by development project linked displacement of people does not strike a chord
in the cities. The possibility of launching a peoples campaign is low in such a scenario. There is
a thin line between peoples struggles and advocacy. Peoples struggles raise issues and slap the
government to take notice of these issues. Advocacy involves building up a fact-based and
analytical understanding of issues to strengthen the peoples struggles. The two do not
themselves look for solutions to problems but try to force society and the state to take up the
task of looking for solutions.
Advocacy is a process that takes up one or several linked issues with the objective of bringing
about a change. When we work on any issue, case or incident there are three objectives we
have in mind: The affected individual, people or community should receive their rights with
justice. Those responsible for perpetrating injustice should be punished and their accountability
should be fixed so that no abrogation of rights can occur in future. The weaknesses of the
system should be removed, in keeping with these objectives, so that it is no longer unjust in
character.
And finally, we must ourselves clearly understand that human rights cannot be defined without
justice. And justice cannot be limited to the courts but must permeate and become an integral
part of society, the state and the system. Change cannot happen only by formulating policies or
making laws. It requires provisions being made for an administrative, economic and
infrastructural system (buildings, equipment, roads, water supply, sanitation, etc.), creating an
accountable grievance redressal mechanism that works in a time-bound manner. We would
have to decide the values and standards that govern this system and the government should
pledge to adopt these values and standards.
 Policy of Cash Transfers
CASH-FOR-FOOD FORMULA SPELLS THREAT
In the new dispensation, since 2005, the government has adopted a policy of transferring cash in lieu of
the subsidies it provides to people under various welfare services (health, education, agriculture, rations
etc). Government of Delhi has initiated a pilot on Cash for Food in 2 urban slums. It seems determined to
pursue this course of action, the logic being that people can then be free to buy such services in the
open market. Therein lies a tale. The World Bank and United Nations Development Programme are the
main key organizations pushing cash transfer policies in India. The UNDP in their paper on the issue
argues that Cash transfer schemes are also being advocated in the Indian context as a measure of
enhancing the efficiency of delivery of government programmes. It is well-known that the administrative
cost of delivery of services in the country is high, there are substantial leakages and inter-sectoral
coordination is not optimal2. It has been argued by some that the amount of Rs. 2,000 billion that is
spent annually on food, fuel and fertilizer subsidies may be better utilized by providing cash directly to
the beneficiaries or to the Gram Panchayats (locally-elected village councils) who inturn can implement
schemes for the poor.CCT schemes have been observed to promote more regular health check-ups
among pregnant women and children in countries with good and functioning health infrastructure.9
International Financial and UN Development Institutions have been pushing the concept by saying that
people do not receive their entitlements and benefits related to basic services, so it is the time to adopt
alternatives, and the best alternative is Transfer Cash, instead to providing services and substance.

Furthermore on the one side of the debate; UNDP in its paper on Conditional Cash Transfers advocates
for conditional cash transfers for improving education level, health indicators and social wellbeing by
saying Conditional cash transfers are different from unconditional cash transfers grants to vulnerable
persons/groups on the basis of certain pre-determined eligibility criteria. Social transfers such as
pensions to senior citizens, the physically challenged, children, etc., are the most common unconditional
cash transfers. The main difference as compared to CCT schemes is that they are unconditional
programmes and do not attempt to influence individual/household consumption preferences. They
recognize the vulnerability of those whom the scheme addresses and make a provision of a cash grant to
enable individual/group coping mechanisms, often in response to guaranteed human rights. These
constitute protective social security measures. BUT on the other hand UNDP has provided funding of
$10 million in 4 phases to Delhi Government for piloting Cash for Food, which will replace food from
Public Distribution System.

And on the other side of it; In a survey conducted by the National Federation of Indian Women (NFIW)
and the Right to Food Campaign in Delhis slum settlements in May-June 2011, a mere 201 out of the
4,005 BPL (below poverty line) women interviewed stated that they preferred cash transfers, whereas
91% of BPL families want distribution of subsidized food grains to continue. But for sure they look
forward to structural improvements in the Public Distribution System.
During documentation of a series of case studies on Food Insecurity and Hunger among Tribals in
Madhya Pradesh by Vikas Samvad, it is found that people from tribal communities overwhelmingly
prefers food and do not expect cash for food due to various practical reasons and constraints. Seventy-
9
http://www.undp.org.in/content/cct/CCT_DP.pdf
year-old Puswa Mawasi of Madulihai village in Madhya Pradeshs Satna district possesses a BPL ration
card. But he has never received more than 20kg of food grains, mostly of inferior quality. Very often he
visits the ration shop only to find it shut. Sukvariya, a 68 years old woman, has a similar story to narrate.
Anjanwada is a village in Sondhwa tehsil of Alirajpur district that has been affected by the Sardar Sarovar
project. The dam has submerged the livelihood resources of 60 of the 63 families residing in the village,
yet all these families have been allotted APL (above poverty line) ration cards. If any villager falls ill, a life
taking crisis is created because it takes three hours by boat to navigate the reservoir waters to the
nearest primary health centre (which is almost always shut). Let me clarify, there is no public transport
system has been shaped by the Narmada Valley Development Authority or State Government.
During our field survey we asked Puswa Mawasi whether people would be willing to accept a system of
cash transfers as an alternative to foodgrain rationing, considering the dismal state of the public
distribution system. He thought for a while before replying, Then we would have to go to Majgawan
tehsil headquarter to get our rations form the private dealer. After a further pause, she added, The
cost of foodgrains keeps going up day by day. That would be the end of us and we would all die of
hunger. He adds Our Government took more than 12 years in increasing oldage pension amount. No,
we only want food.
Sukvariya Bai chipped in, Cash? No, never. Even today it is the liquor contractors spell death for us. If
cash flows, in place of food, it would not go for food grains but be spent on liquor and gambling. The
young seek new pleasures every day. Every rupee we get would be splurged on such frivolous pastimes.
Just reform the ration shops and their staff. Thats enough for us.
The other adivasis of Anjanwada also speak with one voice. Will we be cured if cash comes into our
hands? The hospital staff already fleeces us. Things would get even more difficult with private
healthcare. No, we dont want cash. Just give us foodgrains and healthcare, they say.
K. Seethaprabhu, senior assistant country director in India for the United Nations Development
Programme in her paper titled Can Conditional Cash Transfers Work in Rural India? writes that The
Indian government is seriously studying the implications of introducing such programs to address India's
nutritional challenges. In March 2008, "Dhanalakshmi" -- a CCT for female children with insurance cover
-- was introduced on an experimental basis in 11 educationally backward blocks across Andhra Pradesh,
Uttar Pradesh, Bihar, Orissa, Jharkhand, Chhattisgarh and Punjab. The program provides for cash
transfers to the family of a female child on their fulfilling specific conditions: birth and registration of the
child, immunization, enrollment and retention in school. If the girl remains unmarried at the age of 18,
insurance cover of 100,000 rupees will be given to her. There are several state governments which have
launched variations of CCT programs, providing incentives to promote the birth, survival, as education
girls. For example, the Ladli scheme of the governments of Delhi and Haryana puts money in the bank at
various stages and the full amount is provided to the girl when she turns 18. This approach remains
question of inequality unanswered. Also on the one hand, while advocating conditional cash transfers,
institutions like UNDP also merging it with un-conditional cash transfers, which makes issues more
complex. And on the other hand they do note emphasize the need to strengthen the public service
institutions like schools, hospitals and public distribution system.
World Bank in its report Social Protection for a changing India launched in May 2011 said that No
country in the world has a well-functioning PDS system. India is no exception. Indias public distribution
system has limited benefits due to huge leakage and wastage. And finally recommended cash transfer
as an alternative to provide subsidized food for the poor. I am quoting a part of the news report (based
on the above mentioned World Bank report) on the World Bank recommendation which says Leakages
and diversion of grains are high. Only 41 per cent of the grains released by government reach
households, according to 2004-05 NSS (the latest data available) with some states doing much worse. In
2001, the planning commission has estimated this leakage of BPL grains at 58 per cent nationally. This
report was prepared on the request of Government of India that shows that Indias policy makers and
World Bank traveling on the same boat and do not believe in Drastic Reforms in PDS, instead of reform,
they are ready to dismantle it. They dont want to hire the argument that PDS is fundamentally required
to protect food producer farmers, price fluctuations and food security of the country at large. They all
forget India is not a country of 85% Urban population or 5% poor population, where cash transfers have
worked up to an extent. It is still a rural economy based country, where 77% population survives by
spending just Rs. 20 ($ 0.44) per day. Indias population can not afford to be a consumer; it will have to
have control over the production and public service delivery mechanisms for ensuring equality and
availability of basic essential services, which we demand as entitlements.
It is now being openly accepted that the government system is so barefaced, unaccountable, corrupt
and disorganized that it cannot deliver basic services to the citizens of this country. Thus any direct
government hand in administering rationing of food grains, healthcare, education and social security
would mean the breakdown and ruin of these services. Thats why its being said that its better that
people begin to accept a system of receiving cash relief in accordance with certain eligibility conditions.
In the financial year 2010-11, the central and state governments spent a total of Rs3.69 Lakh Crores on
the social welfare sector (education, healthcare, livelihood, social security, etc). The total amount of
subsidy on social sector in 2011-12 is Rs1.62 Lakh Crores, which is about Rs20, 000 Crores more than in
the previous year. In a sense public expenditure on social sector is anyway on decline, and cash transfer
policy would contribute further in this decline.
While such privatization and reimbursements are relatively recent practices, similar experiments have
been going on for the past 10 years in the field of health insurance. The learning from these experiments
should make us pause and think. Since these private health insurance companies are not constitutionally
bound to provide services to the people, their only aim is to earn profits, for which purpose they levy
high costs regardless of whether a cure is affected or not. Free from any legal accountability, they
establish different categories and standards for various services solely with the intention of hiking the
costs.
Government insurance companies, on the other hand, may be guilty of often delaying health insurance
payments but people are, nevertheless, assured of getting the required services.
Cash transfers are thus merely extensions of the contractual system.
The Planning Commission sees benefits in adopting such a system, asserting that the government should
not have a direct administrative role in the social sector. It advocates that the government should either
shut down its ration shops, hospitals and welfare programmes or else adopt a policy of direct cash
transfers in lieu of these services in order to enable the private sector to develop. In a paper titled
Introducing Conditional Cash Transfers in India: A Proposal for Five CCTs (2010, Planning Commission
spoke the same words, as World Bank wanted. This report said India has had a long history of
untargeted or poorly targeted subsidies, which are in need of replacement, especially because the fiscal
burden of these subsidies has become increasingly unbearable after the multiple fiscal stimuli post-2008
economic crisis. The Department of Food and Civil Supplies in 2008 asked for a Rs. 242 Crore budget to
provide Food Coupons instead of Food Grains and allow people to go and use it as Cheque to buy food
from the open market. Once it is properly set in place, Public Distribution System will be shut down.
This year, while reading his budget speech in parliament, Finance Minister Pranab Mukherjee stated that
instead of distributing subsidized kerosene and food grains the government would directly deposit cash
payments into the accounts of the beneficiaries. When it was pointed out that such cash transfers may
prove inadequate if prices of kerosene and food grains rise once official control is withdrawn, the
government had no answer on who or how security would be provided to the people against such
market fluctuations.
The only refrain it gave was that since the subsidies provided under various welfare programmes seldom
reach the beneficiaries the only real solution was to directly transfer cash to them. This would give them
the freedom to choose whichever alternative service or commodity they desire that is available in the
open market.
The fear then was that the government would apply this policy to the public distribution system, using
the technique of transferring cash in place of providing foodgrains. This fear is now becoming the reality.
The version of the National Food Security Bill approved by the ruling governments cabinet committee
has a provision to gradually transfer cash amounts in place of foodgrain rationing. While dealing the
with the question of reforms in PDS, Government of India in the proposed NFSA (draft approved by the
Cabinet) opens its cards on Cash transfers. The Chapter 13, Section 3(g), of the Bill says: Introducing
scheme for cash transfer to the targeted beneficiaries in lieu of their foodgrain entitlements in areas
and manner to be prescribed by the Central Government.
It costs Rs3.65 for every rupee of development funding to percolate down to the beneficiaries. If the
relief meant for poor families in the 150-odd Central and State government-run programmes is
transferred in cash it would mean that each Poor and Vulnerable family would receive Rs2,140 every
month, which would raise them above the poverty line. But will this amount suffice to provide them
access to foodgrains, healthcare and education at the prevailing open market rates?
Until now, the poor have been receiving services directly from the government, which limits the scope
of corruption to some extent. Once they begin receiving cash amounts, fraud will increase.
Today 42 Crores of Indias most destitute are able to survive because the public distribution system
provides them 35% of the food grains they require. However, the sad fact is that there is no true
assessment of poverty in the country. As much as 39% of the poor population does not even have a
ration card so they get no government welfare relief whatsoever.
The government system cannot be made accountable or rid of corruption so the alternative proposed is
not to reform it but to divest it of its purpose and functions and let the people repose their trust in the
market.
India is steadily moving towards creating a system of cash transfers in accordance with certain eligibility
criteria. Whether it is Foodgrain payments or health services payments, the government would make
cash transfers only to those it accepts as poor. According to present official criteria, a poor family in a
village is one that spends less than Rs15 per capita, the amount in urban areas being Rs20 per capita.
Such exercising of government discretion in transferring money raises some basic fears that cannot be
wished away that the system may no longer remain public or open.
The Nandi Foundation, which supports the idea of cash transfers and putting an end to government
involvement in social welfare administration, conducted a survey in 12 districts of Madhya Pradesh in
2010 to assess the opinion of beneficiaries about the policy change. It found that 95% of women
opposed the idea of dismantling the Foodgrain distribution system and replacing it with cash transfers.
Women firmly believe that the cash will never come into their hands because in most families, control of
money is in the hands of males, who do not always spend it on basic necessities.
Forty economists from around the world (working in internationally renowned Universities like Harvard,
LSE, D-School, IGIDR, ISI, Princeton, Columbia, Warwick etc) have written10 to the prime minister urging
the Universalisation of the public distribution system. They have also appealed against cash transfers
replacing Foodgrain rationing. Acting on the appeal of these learned economists, an intensive study of
1227 households was undertaken in March-June 2011 in 100 randomly selected villages of nine districts,
including Andhra Pradesh, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Orissa, Rajasthan, Tamil
Nadu, and Uttar Pradesh under the leadership of Indian researchers Prof. Jean Dreze and Ritika Khera11.
The study revealed that 91% of the people in Andhra Pradesh, 88% in Odisha, 90% in Chattisgarh, and
81% in Himachal Pradesh want only foodgrains. Only 11% in Tamil Nadu, 15% in Rajasthan, and 22% in
Jharkhand prefer cash. It is revealing to note that among those giving priority to cash, most are males.
The people surveyed pointed out that there are no other shops apart from the government ration shop
in most habitations so where could they go with cash? At least at the moment, food grains are available
and are also distributed equally but with cash there would be no such equity.
The Indian initiative appears to be influenced by the cash transfer programmes prevalent in South
American countries. These are countries where urbanization has been taking place for the past 200 to
300 years and 80% of their populations live in cities. Gender discrimination is comparatively low, as is
corruption and poor quality of services.
Our Planning Commission fails to see that these countries have developed stable welfare services. They
have provisions to extend economic help to families with school-going children and the programmes are
successful because the school system works well. They also have hospitals and other services, which
makes cash transfers a meaningful exercise. Whereas in India the infrastructure for basic welfare
services is collapsing, so any policy of cash transfers could have disastrous results here.
We need to be clear about the consequences before deciding to operationalise any system of
conditional cash transfers. Seventy percent of Indias population still lives in villages where few banking
institutions are available. As many as 26,000 Rural Banks have downed their shutters since 1992 and
commercial banks have shown no interest in social welfare schemes. Thats why its difficult to reach
cash to village populations.
We have seen cash disbursals being made to promote maternal security and pension schemes but even
in these cases many beneficiaries do not receive their rights because of corruption. This proves that cash
transfers do not put an end to corruption as claimed by proponents of such a course of action.
Eventually, we need to reform and strengthen our infrastructure and systems and make them more
accountable.
In this context, it is important to note that the Supreme Court has defined food, nutrition, and social
security as basic human rights. These rights cannot be compromised or curtailed with weapons like BPL
eligibility and other conditions.
Conditional cash transfers limit basic rights. They have only been successful where government systems
are capable and influential. In India, the government system is weak and helpless. In such a scenario, the
monopoly of the private sector can prove dangerous.

10
http://articles.economictimes.indiatimes.com/2011-06-01/news/29608448_1_pds-shops-public-distribution-
system-national-food-security-act
11
http://infochangeindia.org/agriculture/features/a-pds-that-works-is-better-than-cash-transfers.html
It is being said these days that India is now a developed economy and public distribution programmes
only sully the countrys image by suggesting backwardness. Thats why such programmes need to be
discontinued. But the intellectuals fail to realize that the government buys 4 to 6 Crore tonnes of food
grains every year at its minimum support price to run the public distribution system.
If food grains are not distributed through the public distribution system the government would buy less
from the farmers, who would then no longer have the luxury of being able to sell their produce within a
radius of 10km from their villages. This would increase their dependency on companies like ITC and
Cargill, which could lead to a situation where these multinational companies, not the government,
determine Foodgrain prices.
The public distribution system plays and important role in the country, providing security for our
farmers, price control, provision of emergency supplies, and Foodgrain availability in areas/states facing
scarcity. A system of cash transfers would put an end to this role and destabilize the Foodgrain market.
The cash transfer systems of Brazil and Mexico are touted as examples to be followed. But it should be
remembered that only 5% of the populations of both these countries (Brazil and Mexico) are below the
poverty line, whereas the Indian figure is 46%. This means they require a system of cash transfers
catering to only small numbers of beneficiaries, a model which is unlikely to be viable in India.
Similarly, there is a difference between using cash transfers as an alternative to providing basic services
and using them to promote infant care and nutrition in maternal security programmes. If we go around
telling pregnant women to accept Rs 1, 400 and get their delivery done wherever the wish would it be a
wise policy? What we should be doing instead is strengthening our infrastructure and public welfare
systems.
The economic advisory group of the Planning Commission says cash transfers would not only lower the
cost of systems management but would give people the freedom to decide their needs and take steps to
meet them. Okay. But shouldnt we first ask people for their opinion, especially women? Farmers are
also participants in the public distribution system so they, too, need to be consulted. Equally important,
the government should also introspect on its reluctance to strengthen the infrastructure and working of
its public distribution, healthcare and education systems.
What we need to know and understand is whether the government is implementing such policies
merely to benefit the corporate-capitalist forces. If that be the case we need to put a stop to such anti-
people actions.