Here in Bangalore, a city of 6.5 million known for its booming high-technology industry, pleasant climate and good private schools, local health managers commonly pay bribes to senior bureaucrats or elected officials to get good jobs, say investigators, civic leaders and senior civil servants. The health professionals then exact payments from subordinates and patients, emulating their bosses.

"Most of the district health officers have to pay bribes to get promotions and postings, and they in turn collect bribes from their staff and patients," said Hanumappa Sudarshan, the vigilance director for health and education in Karnataka State's anticorruption agency. "It's a vicious cycle."

Mr. Sudarshan's boss, Nanjegowda Venkatachala, a retired Indian Supreme Court justice who heads the agency, put it even more bluntly: "The greed of politicians is ruining the country. There's nothing to mince in this regard."

No matter where the corruption starts, it moves down through the ranks and finally to the poor, for whom it is an inescapable burden.

Though Bangalore has made progress in fighting corruption, it persists in the hospitals. In the narrow lanes of the slums and working-class neighborhoods around the 30-bed Austin Town maternity hospital, families with babies and toddlers described their personal experiences of bribery.

Shobha Rani, the doctor in charge, emphatically disputed such accounts in an interview earlier this year. "I've not come across even one patient who's come here and said I've been charged for anything," she said. "So many times, I've spoken to patients without the knowledge of my staff. I say: 'Tell me the truth. What did you face?' They always give me a good report."

But people who have used the hospital tell a different story. Nagaratna Hanumanthu, 23, and her husband, Hanumanthu, 28, a sugar-cane-juice vendor with a single name, lost their first baby to a raging fever just two days after he was born. Their anxieties were high last November when their daughter was born at Austin Town.