HETA, India – At the entrance to this village in India’s eastern state of Jharkhand, a large pond glistened under the bright autumn sun. Yellow and blue lilies surrounded it. A tailor was stitching clothes outside his shop while a few boys nearby were playing carrom on the lid of a rusted oil barrel.
It was a tranquil, rustic setting – a candidate for a landscape painting, it seemed. But it was also the site of the catastrophe that befell one family in 2007 when it couldn’t put enough food on the table.
Kalicharan Lohra, a 55-year-old retired rickshaw driver who was bedridden with a rare illness, deteriorated that summer when food supplies in his household dwindled. After complaining of chest and body pain, he declined rapidly.
“We massaged his hands and feet,” Mr. Lohra’s daughter-in-law, Munni Devi, recalled. “But his head slowly went cold and he died.”
I visited Heta last November with Ankita Aggarwal, a colleague from the Centre for Equity Studies, a New Delhi think tank. We were on assignment for a major research project that will document starvation deaths in India, examine why they happened and assess government responses to them.
Heta’s story underscored for us that starvation deaths are about much more than food. Often they are the result of the failure of multiple government institutions that are supposed to provide a safety net to the poor. The case also revealed that one well-intentioned public official at the local level can have a hugely positive impact.
In this case, Mr. Lohra’s family’s lack of knowledge of, and access to, medical care clearly put it at greater risk when food supply dried up. Ranchi district, where Heta is located, has the most public health centers of any region of Jharkhand, but villagers say they don’t depend on those free services because treatment is subpar. On average, there is one doctor for every six health centers and local officials say a high caseload makes it impossible for doctors to visit each one regularly. Patients with serious illnesses like tuberculosis and malaria say they get turned away. The only option is paying private doctors who visit the village, but that’s too costly for most locals.
According to the World Health Organization, there are six physicians for every 10,000 people in India, compared with 14 in China. India only spends 1% of its gross domestic product on public health, though it has promised to ramp up to 2.5% of GDP in five years.
Shortages of physicians and funding especially hurt rural households such as Mr. Lohra’s. In a statement in response to written questions, an official at the Ministry of Health and Family Welfare said India’s public health system is “currently geared to meet the health needs of India’s rural poor” and undertakes a variety of initiatives to combat diseases that lead to malnourishment and improve the nutritional status of children, adolescents and lactating mothers.
One afternoon in November we visited Mr. Lohra’s widow, Basanti Devi, at the family’s small, newly painted cement home. Inside, a television was on. We stood in the dirt yard between rows of clothes that hung on a line.
“I have brought up my children with great difficulty,” said Ms. Devi, 47, who looks about 15 years older than her age. She wore a crumpled beige sari. Her brownish-black hair was pinned back in a bun.
Her daughter-in-law, Munni Devi, had given birth to a boy, Kanhaiya, only eight days earlier. The two took turns holding him while we spoke.
Ms. Devi told us she was a domestic worker for many years. She used to clean houses in Ranchi for 300 rupees ($6) per month. That was too little to feed her three children, so she started doing manual labor at construction sites for a daily wage of 60 rupees ($1.20), two to four days a week.
Thirty years ago, Mr. Lohra contracted filariasis, a parasitic disease that can lead to elephantiasis, a thickening of the skin and underlying tissues. Ms. Devi recalled that her husband’s leg started swelling at that time, just before their marriage. By 2004, the swelling got so bad that he was unable to walk and had to stop working.
The couple had three sons: Sanjay, Ajay, and, Krishna. Sanjay was 24 years old when his father retired, but he couldn’t step up to become a breadwinner for the family. When he was 10, he had contracted jaundice and developed a physical disability that affected both legs and left him unfit for manual labor.
Ms. Devi says she didn’t have the money to pay for private doctors and medical care for her husband and Sanjay. She wasn’t aware where the nearest free government clinic was – and anyway wasn’t confident about getting good treatment at public health centers that she says offer shoddy care.
Ms. Devi’s other sons, Ajay and Krishna, also worked on construction sites. The family’s collective income wasn’t enough to buy sufficient food for a household of six. They were only able to get by because Ajay and Krishna also found work on nearby farms for about 20 rupees per day.
Most families in Heta had small plots of land. In lean times, what little amount of rice they produced made the difference between living with hunger and succumbing to it. Ms. Devi’s family, by contrast, had no land and therefore no fallback option.
Before she married Mr. Lohra, he mortgaged his land holdings to another family. The arrangement is known as bandik: a landed family sells its holdings for a specified amount of time, with an agreement to reacquire the land at an agreed-upon date in the future. Ms. Devi did not know the details, but said the family never got its land back.
In 2007, several factors conspired to precipitate the household’s tragedy. First, the government’s “public distribution system,” which is meant to give out discounted grains to the poor, was hopelessly defunct in the area. The local ration shop was closed most days, even though the Supreme Court has ruled in its landmark “right to food” case that shops should be open every day. When the shop was open, the dealer claimed he didn’t have grains to distribute, local villagers said.
At most, Ms. Devi’s family would manage to get government-subsidized grains once every two to three months. And when they did, she says, they never got their full quota of 10 kilograms of wheat, 15 kilograms of rice, and 3.5 liters of kerosene.
In the first nine months of 2007, the family only received a single food ration from the government, Ms. Devi’s ration card records show.
That year, the family’s economic situation became especially shaky. Ajay’s wife, Munni, had given birth to a boy, Kishan, so there was one more mouth to feed. But Ajay had fallen ill with a chronic fever and was not able to work as much as the family needed him to. For long stretches, Ms. Devi and Krishna – the lone healthy son – were the only earners.
According to Munni Devi, the family would eat rice acquired with what little money Ms. Devi and Krishna could bring in. Some days they’d eat maadh bhaat (rice with starch water). When they ran out of food they’d ask for help from neighbors. Most neighbors were relatively better off. But no one was secure enough to offer food consistently.
Other government institutions that are supposed to help families in need – and which the Supreme Court has said are part of people’s constitutional “right to food” – were also in shambles. The National Rural Employment Guarantee program, which is supposed to guarantee 100 days per year of daily wage labor to rural households, did not create any jobs in the area. The Integrated Child Development Services, which guarantees all children in India under the age of six, adolescent girls, and pregnant and lactating mothers free supplementary meals, didn’t receive funds on time from the state. The only program that fared well in the village was one that gave schoolchildren mid-day meals.
Local governance was non-existent in the village. Today the village does have a panchayat – an assembly of village elders. But in 2007, elections had not taken place in Heta so the family had no local politicians to complain to. A functioning panchayat is crucial to enforcing social welfare programs.
That summer, with meager household income and no help coming from the government, Ms. Devi’s family had to endure several-day stretches without food. Lack of clean drinking water and inadequate shelter made matters worse. There was no hand-operated water pump in the village. Rain was leaking through the ceiling of their mud-walled house. It was the kind of environment that experts say can make an undernourished person – whose immune system is already badly compromised – vulnerable to deadly bacterial infections or other illnesses.
On the night of Aug. 7, 2007, Kalicharan Lohra was in immense pain.
That night, Ms. Devi fed her husband two spoonfuls of rice. He complained of intense head and body aches. He got his nightly massage, and died soon after.
Later the same night, their son Sanjay Lohra complained of an intense headache. He was in so much pain he couldn’t even eat the little bit of rice in the house. Five hours later, he died, too.
Balaram, an activist who goes by only one name and is Jharkhand’s advisor to the Supreme Court on matters related to food security, told us local officials declared that the cause of Kalicharan Lohra’s death was filariasis and that Sanjay Lohra died of chronic fever.
We asked the block development officer, who oversees welfare programs in the local villages, and the district collector, the senior bureaucrat in the area, about their views on the deaths. They declined to comment, saying they weren’t in office at the time and didn’t know the details of the cases.
Numerous Supreme Court orders have detailed which programs need to be up and running – from the rural work program to ration handouts to pension packages for poor widows – but those mandates are regularly flouted in places like Heta. The courts don’t have the ability to handle large-scale grievances. The lack of accountability creates conditions where starvation deaths are possible.
Four years after the deaths in Heta, villagers are still being denied most of their entitlements due to poor governance, high turnover rates in the local bureaucracy, insufficient funding of the food distribution program and corruption. That is despite numerous media reports, investigations by activists and visits by high-level state officials.
The rural job guarantee program got up and running in the first half of 2011, but as of our visit, workers were yet to be paid. Kishun Oraon, the leader of the local panchayat, the assembly of village elders, said he isn’t getting consistent funding from the central government. Many villagers continue to migrate to other states for contracted labor to avoid going hungry.
According to Kamal Kishore Soan, District Collector in Ranchi – the most senior bureaucrat in the region – the source of the problem with the job guarantee program is the central government. “This year, we didn’t get funds from the center for five months,” he said. Mr. Soan says he has submitted repeated reports and requests to central government officials, but to no avail.
Officials at India’s Ministry of Rural Development, which is in charge of the rural job guarantee program, were unavailable for comment.
Meanwhile, the health worker who runs the ICDS nutritional program for women and children in Heta, Sita Mani Tirki, told us during our visit she wasn’t getting advance payments from the state government to purchase food and nutritional supplements. Instead, she said, she was keeping the program running by buying rations on credit from local shopkeepers. The state government would then settle her account three to four months later.
Market traders were taking advantage of this. Since she wasn’t paying in cash and payments were eventually coming from public accounts, they were inflating prices. “The shopkeeper is not a social worker,” Mr. Soan said at the time. “He has to have an incentive to provide rations on credit. Which is why he inflates prices.”
Worse, Ms. Tirki told us, 10% of the money the state government sent to settle bills was getting siphoned off along the way by another state official.
In an interview this week, Mr. Soan said he has corrected these problems by successfully petitioning the state to provide local health workers with two months’ worth of cash advances for purchasing rations. Mr. Soan says he has also directed local self-help groups to supply vegetables such as tomatoes, okra, green beans and spinach to village health workers and schools.
The good news is that today all of the villagers in Heta now receive monthly rations. This is due to three changes. First, in September 2011 Heta’s all-women self-help group took charge of grain distribution in the village and proved more efficient and honest than private dealers. The ration shop is now run out of the home of Sushma Oraon, the self-help group’s leader and a local villager. A grain truck from the state warehouse comes once a month, though it doesn’t always bring the full quota of grains the village is entitled to, Ms. Oraon says.
The other changes affected the entire district. Mr. Soan required that all ration shop owners in the district certify with local village councils the amount of monthly grains they distribute. That created a transparent public record to track whether ration shops are distributing all their grains.
At the urging of activists, Mr. Soan also pushed for changes in how grains are transported from the state-run Food Corporation of India’s warehouses to local dealers. The previous ad hoc system was woefully disorganized, with grains getting “lifted” from warehouses a month or more after they were supposed to be delivered in villages. Under the new system, if grains aren’t lifted and delivered on schedule, distributors face penalties or must request extensions. It’s an improvement, though not a total fix to a clunky system.
Basanti Devi’s family’s food situation is better than it was four years ago. More family members are able to work and they earn higher wages, she says. One of the lessons from Heta is that when people demand change, take on responsibilities to see that change through, and have leaders who are willing to cooperate, there’s potential for significant improvement.
“There is a truth to whatever the villagers are telling you,” Mr. Soan told us after we recounted the tale of Ms. Devi’s family. “And we have to admit it. If we want to correct the system, we have to admit it.”
Starvation is a brutal but little-discussed reality in India. The Wall Street Journal’s India Real Time is publishing a six-part series on starvation, showcasing the findings of an investigation by the Centre for Equity Studies, a New Delhi think tank that is researching hunger and advocating reforms of India’s food policies. The series of essays documents the stories of starvation victims, explores the primary causes of their deaths, and argues fiercely that India must overhaul its broken food security system. We welcome your comments and feedback.