Not 80 lakh, but only about 40 lakh persons have benefited through the Tamil Nadu government’s flagship scheme, Makkalai Thedi Maruthuvam (MTM).
The scheme that was rolled out to prevent premature deaths due to non-communicable diseases has lost track, with screenings, new case detection, disease control and disease-specific care plans taking a back seat, and is plagued by inflated numbers, Health Department sources claimed.
It is going to be a year since the scheme, which was rolled out to take healthcare services to people’s doorstep, was launched in the State. But it has run out of its key focus areas, and is revolving around numbers and drug dispensation at the doorstep without focusing on achieving disease control. It has ended up with deficiencies in screenings and fake data entries, reliable sources in the Health Department alleged.
While the Department had claimed that the scheme had reached 80 lakh beneficiaries, the actual number of beneficiaries on the line-list was about 40 lakh. There were instances of duplication of the same person at multiple facilities and overlapping services to the same person, official sources confirmed.
Consider this - “State-wide implementation of the NCD control programme was in 2012. This, along with one year of MTM, should have ensured that the entire population of the State was screened at least two to three times. But this has not happened,” an official source said.
The aim, according to him, was to achieve universal health coverage for all, with specific focus on NCDs. “But the focus is only on the number of drug box distributions and not on drug dispensations,” he said.
‘No proper screening’
Official sources said that with no proper screenings being done, detection of new cases had taken a hit. “According to the STEP survey (a cross-sectional study), if we screen 100 persons, 40 should be detected with any condition, be it diabetes or hypertension. But we are facing screening deficiencies. Many of them are not going on field visits but are engaged in other works and are merely making data entries,” an officer said.
The scheme was run with a workforce of a little over 10,000 persons, including mid-level health providers (MLHP) and women health volunteers (WHV). The treatment plans for diabetes, hypertension, physiotherapy and palliative care and Continuous Ambulatory Peritoneal Dialysis were not being followed. This included a “check once in three months”.
“It looks like we are not concerned about early detection, disease progression and complication management. As a result, we have not implemented MTM fully to achieve control rate,” the official said.
A healthcare staff, who is involved in the scheme, said there was manpower shortage, especially in areas where the population was thick. There was attrition, especially among WHVs, who were paid a meagre incentive of ₹4,500. “Screening is not happening properly. Even palliative care and physiotherapy are not being provided regularly. It is not possible to achieve the daily targets, and we are merely entering fake numbers. We are under pressure to show numbers,” he said.
There were interruptions in drug supply, glucose strips and BP apparatus. As another official source observed: “Unfortunately, the MTM has turned into a target-based programme. The failures include drug availability and BP apparatus. The batteries need to be replaced in the BP apparatus, and WHVs cannot spend from their own pockets when their incentives are not given on time. So, many are making fake entries and issuing drugs.”
Quality checks and monitoring were lacking. “There is a need to look into what WHVs and MLHPs require,” he added.
Health Minister Ma. Subramanian said the screenings were being carried out gradually in the State, with the current reach being around 60%. However, he denied that fake entries were being made. “Wherever we hold inspections, we are verifying the works. It is not possible to hike the numbers. The scheme’s implementation is being monitored by the deputy directors,” he said.
