It has been two years since Rathnalamma Raasa died, and her family still doesn’t know what killed her.

What started as a fever quickly left Raasa, 25, unable to eat or move. Medicines the local health clinic prescribed drained the family’s meager savings but provided no relief. She was unconscious by the time her husband borrowed enough money to visit a government hospital in Visakhapatnam, the nearest city, where doctors said her real illness had gone undetected: falciparum malaria, a parasitic disease that, without timely treatment, had spread to her brain.

She died at the hospital two days later, in August 2013, but the confusion didn’t end there. Her official record lists the cause of death as “cardiorespiratory failure,” a catchall term that means her heart and lungs ceased to function. It doesn’t once mention malaria.

“I still don’t understand what causes malaria … The kids don’t understand what happened,” says her father-in-law, Balaraju Raasa, an elderly farmer who helps care for the three children she left behind. “Until she was about to die, the doctors never told us anything clearly … They just gave us pills and left. I felt like they weren’t telling us the truth.”

The Indian government has spent billions of dollars — about $500 million from 2000 to 2013 — in its fight against malaria, a mosquito-borne disease. International agencies such as the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, a big funder of global public health efforts, have provided major support. The country’s revamped national malaria program is on par with the standard of global care. But its recordkeeping has few admirers. Last year the government recorded only 561 deaths due to malaria, while an independent estimate earlier in the decade shows that the real toll could be as high as 200,000 each year. The disease is especially prevalent among the poor and in India’s vast rural areas, where about two-thirds of the population lives but is served by just 20 percent of the country’s health care infrastructure.

The staggering gap between official data and reality means that thousands of people die without an accurate diagnosis, according to a study by the British medical journal The Lancet. And the government is able to tout the malaria program’s success without a clear picture of how many people are dying. Malaria costs the country nearly $2 billion each year, and the impact of lost earnings and treatment bills falls disproportionately on rural, poor families. An extensive investigation by Al Jazeera America unearthed routine manipulation of malaria data, crippling shortages of essential supplies, chronic understaffing of hospitals and enduring dysfunction in World Bank–funded projects, which led to the Indian government’s returning millions of dollars in aid.

Many health officials privately acknowledge this system-wide failure but say they are helpless. In a review of hundreds of pages of program records, medical supply contracts and village health registers — as well as interviews with dozens of insiders — reporters found that the most serious failures often persist for years in plain sight. But because most victims are poor villagers like the Raasas, hidden from the public eye, this crisis causes little outrage.

Part 1: Disappearing data

Most malaria experts and health practitioners agree that India’s efforts to fight the disease through the National Vector Borne Disease Control Program (NVBDCP) have made headway over the past two decades. Thousands of female community health workers are now armed with blood testing kits, and malaria medications are cheap and widely manufactured. But independent doctors and malaria researchers say progress is hard to measure when the government’s data are wildly inaccurate.

“Malaria deaths happen where political power ends, and data collection suffers when political power is not there,” says Yogesh Jain, a physician and public health advocate with the nonprofit rural health organization Jan Swasthya Sahyog. “Only garbage [data] have gone into the system.”

Reporters found errors and evidence of tampering in every health register in 20 malaria-prone villages in the states of Odisha in the east and Andhra Pradesh in the south. Malaria cases seemed to disappear somewhere along the chain between village health workers taking handwritten notes and the official records at district malaria offices.

Health workers at rural government clinics say they are simply too overburdened to document everything, so sometimes cases don’t make it into the records. At the primary health clinic in Hukumpeta, which serves the Raasas’ village, a lab technician tasked with examining blood samples for the malaria parasite had 800 pending slides the month before reporters visited. With the two other technician posts remaining vacant, the lab could process only 60 slides a day. This kind of backlog can leave sick patients hanging — patients like Rathnalamma Raasa, who was tested at the clinic but never received the result.

Even in better-equipped facilities like King George Hospital, the roughly 1,000-bed facility in the eastern city of Visakhapatnam where Raasa died, stacks of handwritten ledgers detail how deceased patients were diagnosed and treated for malaria but then attributed their deaths to cardiac arrest, kidney failure or fever.

But there is more than a lack of human resources and infrastructure at play. On the surface, the number of malaria cases dropped from nearly 3 million in 1995 to just over 1 million last year, according to the NVBDCP.

Madan Pradhan, the director of Odisha’s malaria program, says the mystery of these lost or misclassified malaria cases is partly because of India’s history of suppressing data, which stems from the early days of the National Malaria Eradication Program, the previous national program, in which officers would lose their jobs over poor health outcomes.

“The fear psychosis was there from then onward,” he says.

Sridhar Srikantiah, a malaria expert who worked as a consultant with the World Bank project in India, agrees. He describes a situation in which every worker in the program was living under constant pressure from his or her supervisor. “The district workers fear their bosses in the state capital. The state workers fear rebuke from the national Health Ministry, which is scared to death of not showing to the global community that India is making progress on this disease.”

Official tallies of malaria deaths are always too low, experts say, because they exclude anyone who may have died of the disease at home — which is why mortality estimates that do include these deaths, such as the one by the World Health Organization, are considered more reliable. But the wide gulf between, say, India’s official record of1,018 deaths in 2010 and The Lancet estimate of 46,800 that year is causing some to worry that bad data are keeping resources from reaching the people who need them most.

“If your whole baseline is faulty, if you are saying that no one is dying of malaria, how can you demand more resources, manpower or decentralization?” said VP Sharma in an interview before his death in October 2015. He had been the director of the National Institute of Malaria Research, an autonomous institute affiliated with the Indian Health Ministry. “You can never reform the system, because you’re saying the problem isn’t even there.”

A.C. Dhariwal, the NVBDCP’s director, accepts that the numbers are flawed but insists the program’s efforts are unharmed because the system accurately captures trends in the spread of the disease.

“Malaria numbers are going down,” he says. “Our biggest challenge is continuing our efforts and consolidating the gains.”

This article was first published on Al Jazeera. Part Two will be published tomorrow.