Because of India’s federal structure, most of the work was carried out by state governments like the one here, run by a lower-caste leader, Mayawati, who once accepted a garland of 1,000-rupee notes from supporters worth about $36,000. Not all of the states were prepared to handle it, and here, at least, much of the money never fulfilled its promise.

Image Lucknow's health care money has drawn dangerous interest. Credit... The New York Times

Some states fared much better, using the money effectively. Supporters of Mr. Hazare say that his demand for the creation of an ombudsman in every state could help stem corruption and protect whistle-blowers.

The central government handed over the cash to Uttar Pradesh with virtually no oversight.

Only after the doctors were killed did a review by the central government’s investigators find that contracts worth millions of dollars were granted without competitive bidding, and millions more was paid in full to contractors who did not complete the work they were required to do, leaving health centers in ruins and without vital equipment. The government failed to make its investigative report public; The New York Times acquired a copy from The Indian Express, a leading newspaper that broke the story about the scandal.

Naseemuddin Siddiqui, Uttar Pradesh’s health minister, said that the state had asked for the central government’s inquiry. Asked for more details, he hung up the phone. Two state ministers have been forced to resign.

It is hard to see where the money went. Two years ago state officials approved a plan to build a 30-bed health clinic in the village of Kurebhar, a three-hour drive from Lucknow. The new clinic would replace a four-bed site, which was straining to provide decent health services for 74 villages. More than $700,000 was budgeted for the project.

The building was supposed to be ready last December. Nearly eight months past that deadline, the health center was still a skeleton of red brick.

“We are trying to push them to do the work faster,” said J. L. Mishra, the chief medical officer in the Sultanpur district. But the government had already paid all the construction fees in advance, leaving almost no leverage.