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Background <p>Non-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.</p> Methods <p>A 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.</p> Results <p>Screening 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.</p> Conclusion <p>MTM 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.</p>

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Makkalai Thedi Maruthuvam: evaluating equity in non-communicable disease care through a doorstep primary health program in Tamil Nadu, India

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月15日

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  • Sudharshini Subramaniam,
  • Anavarathan Somasundaram,
  • Cowshik E,
  • Judson Neslin J,
  • Ponnien Selvan K.N,
  • Jannath Hameeda Banu,
  • Getrude Banumathi,
  • Suganthi Selvarajan,
  • Sabitha Devi Chandrasekaran,
  • Sharon Cynthia

摘要

Background

Non-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.

Methods

A 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.

Results

Screening 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.

Conclusion

MTM 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.