Published Feb 06, 2026 | 7:00 AM ⚊ Updated Feb 06, 2026 | 7:00 AM
The study found that 79.4% of adults had been screened for diabetes, and 82.6% for hypertension.
Synopsis: Rural and urban Tamil Nadu presented two contrasting realities, one where healthcare is welcomed since it is the only lifeline, and another where access itself becomes a barrier, form the findings of a statewide study that evaluates how well MTM is working, and where it is falling short.
In a remote tribal hamlet near Ooty, a man who had suffered a stroke lay confined to his home.
For him, palliative care was not just difficult to access — it was almost unimaginable — until a nurse from Tamil Nadu’s doorstep healthcare programme began visiting him regularly.
“In such places, getting palliative care services is a very, very remote reality,” said Dr Sudharshini Subramaniam, Professor and Head of Community Medicine at Government Vellore Medical College and lead author of a recent study, Makkalai Thedi Maruthuvam (MTM): evaluating equity in non-communicable disease care through a doorstep primary health program in Tamil Nadu.
“This particular patient clearly benefited because the MTM palliative care nurse was visiting him,” she told South First.
Thousands of kilometres away, in Chennai’s dense urban neighbourhoods, the experience could not have been more different. Women health volunteers spoke of locked gates, unanswered doors and visible mistrust.
“People were not willing to engage,” Dr Subramaniam said, recalling the frustration among field workers. “There is a lot of scepticism about allowing a stranger into the house.”
These two contrasting realities, one where healthcare is welcomed since it is the only lifeline, and another where access itself becomes a barrier, form the findings of a statewide study that evaluates how well MTM is working, and where it is falling short.
Published in BMC Primary Care, the study assessed MTM, launched by the Tamil Nadu government in 2021. The programme aims to enhance screening, treatment, and follow-up care for non-communicable diseases (NCDs), including diabetes, hypertension, and selected cancers.
Unlike conventional clinic-based models, MTM relies on trained frontline workers who visit households, screen adults aged 30 years and above, deliver medicines and provide counselling.
Using data from a representative survey of 6,809 adults across all 38 districts, the researchers tracked the entire NCD care cascade — from screening and diagnosis to treatment and disease control.
The results showed that the programme has been remarkably successful in expanding reach. According to the study, 79.4% of adults had been screened for diabetes, and 82.6% for hypertension, with MTM accounting for the majority of these screenings.
The authors noted that “nearly two-thirds of diabetes screening and over half of hypertension screening were delivered through MTM.”
Importantly, coverage was higher in rural areas and among socially disadvantaged communities, including Scheduled Castes and Scheduled Tribes — a reversal of the usual access patterns seen in healthcare.
But while screening and treatment initiation look strong, disease control tells a different story.
Among those diagnosed with diabetes, 97.3% reported being on treatment, yet only 9.8% had their blood-sugar levels under control. Hypertension outcomes were somewhat better, but still concerning: 96.2% were on treatment, while just 35.4% had controlled blood pressure.
“This is where the real challenge lies,” Dr Subramaniam said. “Now, people know there is something called diabetes or hypertension, and they know screening is important. But what happens after screening?”
She stressed that managing chronic diseases goes far beyond prescribing medicines. “There has to be continuous monitoring. Lifestyle modification is equally important, and that needs much more attention.”
The study acknowledged this gap, stating that “high treatment coverage has not translated into adequate disease control,” pointing to adherence issues, lifestyle factors and the need for sustained follow-up.
One of the more unexpected findings was a shift in patients seeking care. The study found that 29.8% of people with diabetes and 26.1% of those with hypertension moved from private to public healthcare services within a year.
While the authors cautioned against attributing this change solely to MTM, they suggested the programme may have strengthened people’s confidence in public healthcare by ensuring regular medicine supply and doorstep delivery.
For patients, especially the elderly and those with mobility issues, avoiding repeated clinic visits can make long-term treatment more feasible.
Dr Subramaniam noted that cost and convenience likely play a role. When medicines come home, continuity of care becomes easier — at least in theory.
The programme’s success is uneven. Urban areas and men consistently lag in screening coverage.
In Chennai, women health volunteers reported difficulty entering households and engaging residents. Dr Subramaniam attributed this to urban scepticism and fear.
“This study was done in 2023. People were concerned about strangers coming in, about safety, even about death,” she said. “Achieving universal access was difficult.”
Men, particularly working-age men, were also less likely to be screened — a pattern seen across India’s public health programmes. The study suggested that MTM’s daytime household visits may inadvertently exclude those who are away at work.
If diabetes and hypertension reflected MTM’s strengths, cancer screening exposed its limits.
The study reported that only 11.1% of eligible women had ever undergone cervical cancer screening, and 14.2% for breast cancer. Oral cancer screening was lower still at 3.9%. Coverage was poorest among Scheduled Tribe women and those from lower socioeconomic backgrounds.
“Cancer screening needs more than doorstep visits,” the authors wrote, pointing to stigma, fear and the need for referral-based follow-up as persistent barriers.
Dr Subramaniam felt that MTM reflects a broader transformation in India’s health priorities. “Earlier, our primary care system was largely focused on maternal and child health,” she said. “Now that we have achieved close to our targets there, attention has shifted to non-communicable diseases.”
She noted that MTM has already gained international recognition, with the programme receiving a United Nations award.
However, she cautioned against premature conclusions. “What we looked at were immediate outputs — screening and treatment coverage,” she said.
“The real question is whether this is improving glycaemic control and blood pressure control. In 2023, it was too early to study that outcome,” she noted.
She also argued that MTM largely focuses on secondary prevention — early diagnosis and treatment — while India’s overstretched health system needs to invest more in primary and primordial prevention, including promoting healthier lifestyles to prevent disease altogether.
As Tamil Nadu’s doorstep healthcare model draws attention from other states, the study offers both encouragement and a warning: bringing healthcare to people’s homes can transform access, but without sustained follow-up and prevention, the last mile of chronic disease control remains elusive.
(Edited by Majnu Babu).
