By JIM YARDLEY

JHABUA,India - Inside the drab district hospital, where dogs patter down the corridors sniffing for food, Ratan Bhuria’s children are curled together in the malnutrition ward, hovering at the edge of starvation.

His daughter, Nani, is 4 and weighs 9 kilograms. His son, Jogdiya, is 2 and weighs only 3.6. Landless and illiterate, drowned by debt, Mr. Bhuria and his children came to the hospital after falling through India’s social safety net.

They should receive subsidized government food and cooking fuel. They do not. The older children should be enrolled in school and receiving a free daily lunch. They are not. And they are hardly alone: India’s eight poorest states have more people in poverty - an estimated 421 million - than Africa’s 26 poorest nations, one study recently reported.

For the governing Indian National Congress Party, which has staked its political fortunes on appealing to the poor, this persistent inability to make government work for people like Mr. Bhuria has set off an ideological debate over a question that once would have been unthinkable in India: Should the country begin to unshackle the poor from the inefficient, decades-old government food distribution system and try something radical, like simply giving out food coupons, or cash? The rethinking is being prodded by a potentially sweeping proposal that has divided the Congress Party. Its president, Sonia Gandhi, is pushing to create a constitutional right to food and expand the existing entitlement so that every Indian family would qualify for a monthly 35-kilogram bag of grain, sugar and kerosene.

Such entitlements have helped the Congress Party win votes. Many economists and market advocates within the Congress Party agree that the poor need better tools to receive their benefits but believe the existing delivering system needs to be dismantled, not expanded.

They argue that handing out vouchers equivalent to the bag of grain would liberate the poor from an unwieldy government apparatus and let them buy what they please, where they please. “The question is whether there is a role for the market in the delivery of social programs,” said Bharat Ramaswami, a rural economist at the Indian Statistical Institute. “This is a big issue: Can you harness the market?” India vanquished food shortages during the 1960s with the Green Revolution, which introduced high-yield grains and fertilizers and expanded irrigation, and the country has had one of the world’s fastest-growing economies during the past decade.

But today, its poverty and hunger indexes remain dismal, with roughly 42 percent of all Indian children under the age of 5 being underweight. The food system has existed for more than half a century and has become riddled with corruption and inefficiency. Studies show that 70 percent of a roughly $12 billion budget is wasted, stolen or absorbed by bureaucratic and transportation costs.

Ms. Gandhi’s proposal, still far from becoming law, has been scaled back, for now, so that eligibility would initially be introduced only in the country’s 200 poorest districts, including here in Jhabua, at the western edge of the state of Madhya Pradesh. With some of the highest levels of poverty and child malnutrition in the world, Madhya Pradesh underscores the need for change in the food system. Earlier this year, the official overseeing the state’s child development programs was arrested on charges of stealing money.

In Jhabua, local news media recently reported a spate of child deaths linked to malnutrition in several villages. Investigators later discovered 3,500 fake food ration booklets in the district, believed to have been issued by low-level officials for themselves and their friends.

To Ms. Gandhi and her left-leaning allies, making food a legal right would give people like Mr. Bhuria a tool to demand benefits that rightfully belong to them. Inside the district hospital, Mr. Bhuria said he had applied three times for a food ration card, but the clerk had failed to produce one. “Every time he would say, ‘We will do it, we will do it,’ ” Mr. Bhuria recalled. “But he never did.” He and his wife migrated with their children to work as day laborers in the neighboring state of Gujarat.

Working in Gujarat is common for farmers from Jhabua, but since none can use their ration booklets outside their home villages, they struggle to feed their families. When migrants returned to plant their fields in July, the malnutrition wards began to fill up at the district hospital.

“This is a cycle,” said Dr. I. S. Chauhan, who oversees the wards. “The mother is also malnourished. And they are migrant workers. They work all day and can’t care for their children.

India’s food distribution system is rife with corruption and inefficiency. A starving boy with his mother in Jhabua. Women, with ration cards in hand, line up hoping to buy grain at a Fair Price Shop, below.