why is it that the world's greatest democracy also has the world's meanest state apparatus?

The state apparatus in India works on a self-decocted modern variation of feudal over-lordship. Vassalage is what makes it tick. To that extent it functions beyond checks, and banishes balances. It can override accountability and public good. It must keep people poor and, even better, unwell.

Only go to district Sonbhadra in Uttar Pradesh. In Chopan, a block (administrative unit) within this district, every child is deformed. In village after village populated by poverty-stricken adivasis, women's spines bend unluckily by age 25 and definitely by age 40, so that they can't run the household anymore. What afflicts these people? (see: State sponsors disability [2])

In fact the question should be: what is inflicted upon these people? What is inflicted is an administered nightmare that turns the locomotive limb and live torsos into a bumbling caricature of itself. What is inflicted is a grotesque deformation that spans the sub-continent