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

Sep 23, 2026

Non-communicable diseases (NCDs) disproportionately harm marginalized populations through delayed diagnosis and weak continuity of care. “MakkalaiThedi Maruthuvam” (MTM) is a state-led doorstep primary health initiative in Tamil Nadu, India, providing home-based screening and NCD management to reduce access barriers and improve equity. This cross-sectional household survey evaluates program performance across the care cascade, examining screening, diagnosis, treatment, and control for diabetes, hypertension, and cancers using handheld digital tools and equity analyses by gender, location, caste, and socioeconomic status.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Key messages

Why this is relevant

What is already known

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Keywords

Introduction

Subramaniam etal. BMC Primary Care (2026) 27:17 [https://doi.org/10.1186/s12875-025-03064-w](https://doi.org/10.1186/s12875-025-03064-w) BMC Primary Care RESEARCH Open Access MakkalaiThedi Maruthuvam: evaluating equity in non-communicable disease care through a doorstep primary health program in Tamil Nadu, India Sudharshini Subramaniam 1, Anavarathan Somasundaram2, Cowshik E3*, Judson Neslin J4, Ponnien Selvan K. N5, Jannath Hameeda Banu6, Getrude Banumathi 1, Suganthi Selvarajan7, Sabitha Devi Chandrasekaran8, Sharon Cynthia9 and MTM study group Abstract Background Non-Communicable Diseases (NCDs) disproportionately affect marginalized populations, often due to delayed diagnosis and poor continuity of care.“MakkalaiThedi 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. *Correspondence: Cowshik E [cowshik.esswaran@gmail.com](cowshik.esswaran@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Key messages Why this is relevant? The Makkalai Thedi Maruthuvam program demonstrates how community-based, doorstep primary care can reduce access inequities and improve NCD service coverage among marginalized populations—offering a scalable model for advancing health equity through implement

FAQs

What is the MTM program and what does it aim to improve?

MTM is a state-led doorstep primary health program in Tamil Nadu that provides home-based screening and care for NCDs. It aims to overcome access barriers and improve health equity across underserved groups.

How was the study conducted to evaluate equity in NCD care?

A cross-sectional household survey covered all 38 districts in Tamil Nadu, using multi-stage cluster sampling. It collected data on screening, diagnosis, treatment, and control for diabetes, hypertension, and cancers using handheld digital tools.

What were the main findings on screening, treatment, and disease control?

Screening coverage was relatively high for diabetes (79.4%) and hypertension (82.6%), and most diagnosed patients received treatment (>95%). However, control rates remained low (9.8% for diabetes; 35.4% for hypertension), and cancer screening coverage was substantially lower with disparities by caste and economic groups.

Sep 23, 2026

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