Ms V. Sasikala and Ms H. Hemalatha pack their biodegradable jute bags with diagnostic kits and medicines and don bright pink jackets every morning to visit 25 homes to deliver primary health services at people’s doorsteps, literally. They are trained women health volunteers who, under Tamil Nadu’s Makkalai Thedi Maruthuvam (MTM) initiative, visit homes to screen people over 30 years for non-communicable diseases (NCDs) including diabetes, hypertension and mental health disorders, tuberculosis (TB), nutrition, among others. They also deliver medicines for chronic conditions to at least 20 beneficiaries every day and review their compliance to prescription medication for optimal disease management and treatment.
MTM volunteer Ms V. Sasikala measuring Ms Vanitha’s blood pressure at her home in Makkaram Thottam in Kolathur, Chennai (Photo: Sanchita Sharma / © WHO India)
Ms Vanitha is one of the many thousands of beneficiaries of the MTM scheme in Chennai. She has high blood pressure and diabetes but gets regular medical treatment and care without stepping out of her home in Makkaram Thottam in Kolathur, Chennai. Ms V. Sasikala and Ms H. Hemalatha visit her at home to measure and record her blood pressure and blood glucose levels, deliver her monthly dose of prescription medicines, and ask her a set of questions about her health, including aches and pains, disease symptoms, diet, sleep and mental health. They also screen her son, Mr Murali Mohan, 39, who has no diagnosed disease but qualifies for NCD screening since he is over 30 years old.
Services for NCDs management, TB, undernutrition and mental health have been integrated to provide patients comprehensive continuum of care. People with diabetes are at higher risk of TB and have poorer treatment outcomes. Women health volunteers screen people for hypertension, diabetes, mental health issues and collect sputum sample from symptomatic people for testing for TB at the Urban Primary Health Centre (UPHC). All UPHC diagnostics labs are equipped for sputum testing for TB and the results are ready within a day.
Women health volunteers Ms Kanchana and Ms Kannagi work in close coordination with NCDs staff nurse Ms P. Manjupriya at Thiru. Vi. Ka Nagar Urban Primary Health Centre in Chennai (Photo: Sanchita Sharma / © WHO India)
Global data indicates that diabetes is associated with a twofold to threefold risk of TB disease, a twofold risk of death during TB treatment, a fourfold risk of TB relapse after treatment completion, and a twofold risk of multidrug-resistant TB. In 2020, an estimated 370 000 new cases of TB worldwide were attributable to diabetes, according to Global Tuberculosis Report 2021. WHO Collaborative framework for care and control of TB and diabetes recommends establishing mechanisms for collaboration, detection and managing TB in patients with diabetes.
MTM volunteers trained by Tamil Nadu Corporation for Development of Women are at the forefront of this collaboration. To strengthen community-based health services with integrated care for TB patients with comorbidities, Tamil Nadu State Tuberculosis Cell has trained and incentivized these women health volunteers for active TB case detection, with each volunteer receiving Rs 500 for every positive TB case they help detect. MTM volunteers also counsel and support patients to adhere to the complete course of TB treatment, which lost-to-follow-up during treatment.
Mr R Gopinath being counselled on lifestyle modifications after being newly diagnosed with high blood pressure during a routine checkup by women health volunteers (Photo: Sanchita Sharma / © WHO India)
All 140 UPHCs in the Greater Chennai Corporation area provide diagnostic and treatment services to people screened by MTM volunteers. Two suspected TB cases identified by woman health volunteer Ms Kanchana tested positive and are now on six-months treatment under the supervision of the medical staff at Thiru. Vi. Ka Nagar Urban Primary Health Centre.
“All TB cases are notified and there are monthly follow-ups with every patient. Women health volunteers collect sputum for testing from symptomatic people. An ‘irregular patients’ list is also shared for follow-up with sanitory inspectors, who visit 80 houses every day to look for mosquito breeding sites. The loss to follow-up has reduced drastically since we have involved other sectors. We don’t work in silos,” said Dr Lavanya J., District TB Officer, Greater Chennai Corporation, which is leading Chennai TB Free Project.
Dr Lavanya J. (extreme left), district TB officer, Greater Chennai Corporation, receiving feedback on the quality of services from a TB patient (right) getting treated at Thiru. Vi. Ka Nagar UPHC, Chennai (Photo: Sanchita Sharma / © WHO India)
UPHCs also provide specialized care to the communities they serve. “Polyclinics on different specialties are run every day from 4-8 p.m. by specialists in general medicine (internist), psychiatry, palliative care, ENT, nephrology, ophthalmology, dermatology, paediatrics, and obstetrics and gynaecology. The response from the community has been very good,” said Dr Jaya Priyanka, medical officer, Kolathur UPHC in Chennai.
India’s National Strategic Plan for TB Elimination has goal of ending TB by 2025, five years ahead of the global targets, using a multi-pronged approach that includes decentralized screening and treatment services closer to the community through Integration with Ayushman Bharat - Health and Wellness Centres. WHO India provides technical and field support to the Ministry of Health & Family Welfare to assist in accelerating actions to end TB.