Qualitative assessment of people centeredness of the Makkalai Thedi Maruthuvam scheme in seven villages of Tamil Nadu

The Makkalai Thedi Maruthuvam (MTM) scheme, launched in Tamil Nadu in August 2021, shifts non-communicable disease (NCD) care from centralized facilities to a community-based model. This study aimed to assess the level of people-centeredness of the MTM scheme in seven specific villages of the Thiruvallur District of Tamil Nadu. A qualitative case study approach was utilized across seven villages, three with a functional community-based MTM scheme and four without. Ten to twelve elders living with NCDs and eligible for MTM services were purposively sampled from each village. Data were collected through seven focus group discussions (FGDs) and analyzed using thematic content analysis. The community-based drug delivery was not uniformly functional, primarily due to a lack of dedicated Women Health Volunteers (WHVs). In villages where community services were dysfunctional, reliance on Primary Health Centers (PHCs) was mandatory, but most PHCs were perceived as inaccessible due to distance and poor public transport, compromising the MTM’s core objective of improving access. While a positive perception of drug quality and the financial protection of the scheme existed, some participants reported being devalued or disrespected at PHCs, highlighting a gap in relational people-centeredness. Furthermore, a lack of transparent communication and community engagement in the planning process was a recurrent source of dissatisfaction and distrust. The MTM scheme exhibits systemic people-centered strengths, such as financial protection and accessible drugs. However, it is undermined by non-uniform functionality, poor accessibility of facility-based services, and a severe lack of relational people-centeredness and community engagement in planning.