Doorstep medicare has reached vulnerable groups: survey
A Statewide, crosssectional survey has found that Makkalai Thedi Maruthuvam (MTM), a scheme to deliver medical care at people’s doorstep, has reached the most vulnerable groups, such as women in rural areas and the Scheduled Castes and the Scheduled Tribes.
While diabetes and hypertension were the most widely covered noncommunicable diseases (NCDs) under MTM, cancer screening coverage was extremely low, it found.
The State Planning Commission, as part of its evaluation of the State government’s flagship schemes, proposed to evaluate the care delivered through MTM. The Institute of Community Medicine, Madras Medical College, conducted the survey in coordination with the Community Medicine Departments of other government medical colleges.
The survey, conducted among people aged over 30, had a total sample size of 5,760 households. Of the participants, 4,155 (60%) were from rural areas and 2,701 (40%) from urban areas. A total of 2,575 men and 4,279 women were surveyed. While 24.8% of the participants did not wish to reveal their community, among those who did, 2,416 belonged to the BCs; 1,589 to the MBCs; 825 to the SCs; and 220 to the STs.
Nearly 78.84% of the participants were aware of MTM, and 73% had been visited by women health volunteers (WHVs). As for the screening for hypertension, 81.25% of the population had been screened, and 93.8% of them were screened in the last year. Among those screened in the last year, 73.6% were screened through MTM.
The study also found that more women (82.6%) were screened than men (79%). More women were screened than men under
MTM in the last year (75.1% as against 71.2%). Under MTM, screening by field workers at the doorstep was higher among men than women.
Urbanrural difference
The survey highlighted an urbanrural difference in hypertension screening coverage.
Screening through MTM for hypertension was 61.5% in urban areas as against 82.9% in rural areas. The coverage was significantly higher among the SCs and the STs than other categories. The ST population screened through MTM field workers stood at 91.4%.
It found that 22% of the study population were hypertensive. Among those diagnosed with hypertension, onefifth were diagnosed in the last one year and 96% were reported to be undergoing treatment. Among hypertensive patients, twothirds were receiving treatment under MTM, and 41% of these patients had received treatment at their doorstep through field workers. The survey found that 35% of the hypertensive patients had their blood pressure under control.
As for the screening for diabetes, the survey found that 80% of the participants had been screened. A total of 93% of them were screened in the last one year, and of them, 69% were screened under MTM. The proportion of people reported to be diabetic was 21%.
Among those diagnosed with diabetes, 16.6% were diagnosed in the last one year and 97% were reported to be on treatment. More than half of those with diabetes received treatment under MTM, and 36% received medicines from field workers. It found that nearly 10% of the diabetics had their sugar levels under control.
The cancer screening was low — only 4% of the participants had undergone screening for oral cancer; 11.06% of women for cervical cancer; and 14.24% of women for breast cancer. Counselling for cancer screening was also low.
The study recommended increasing the demand for cancer screening by creating awareness and giving priority to counselling. WHVs may be adequately trained in cancer screening counselling, it said.
Pointing out that women had better coverage than men, the study said that men had a higher disease burden of diabetes and hypertension, and needed focused policies in place.
Since its launch in August 2021, MTM has covered 1,00,74,664 beneficiaries for firsttime service, and a total of 3,85,89,977 beneficiaries have been provided repeat services as of March 13 this year.
While diabetes and hypertension were the most widely covered non-communicable diseases under the scheme, cancer screening was extremely low