ArticleBMC primary care2025
Makkalai Thedi Maruthuvam: evaluating equity in non-communicable disease care through a doorstep primary health program in Tamil Nadu, India.
Article in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-Communicable Diseases (NCDs) disproportionately affect marginalized populations, often due to delayed diagnosis and poor continuity of care. "Makkalai Thedi Maruthuvam" (MTM), a state-led initiative in Tamil Nadu, India, delivers home-based screening and care services for NCDs, aiming to overcome access barriers and promote equity. This study evaluates the program's performance in delivering NCD care across key steps of the care cascade.
methodsA cross-sectional household survey was conducted across all 38 districts in Tamil Nadu, covering 6,856 adults aged ≥ 30 years through multi-stage cluster sampling. Data on screening, diagnosis, treatment, and control of diabetes, hypertension, and cancers were collected using handheld digital tools. Descriptive and inferential statistics were used to assess equity across gender, location, caste, and socioeconomic status.
resultsScreening coverage for diabetes and hypertension was 79.4% and 82.6%, respectively, with over two-thirds of services delivered by MTM field staff. While over 95% of diagnosed patients were on treatment, control rates remained low (9.8% for diabetes; 35.4% for hypertension). Cancer screening coverage was substantially lower, with notable disparities across caste and economic groups. Rural and SC/ST communities had greater program reach, but urban areas and male populations lagged. Approximately 30% of patients shifted from private to public care within one year.
conclusionMTM has significantly improved access to NCD care among marginalized populations through a community-based implementation model. However, challenges remain in ensuring equitable cancer screening, improving urban outreach, and achieving disease control. The study underscores the importance of community health workers and doorstep strategies in advancing health equity through primary care systems.
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