The COVID pandemic has exposed the frailties of institutional based care delivery as access to drugs, dialysis facilities, palliative care, geriatric services etc were compromised during the lockdown resulting in increased morbidity due to non-COVID reasons. There is a need for a comprehensive health system which provides holistic home based health care services addressing the health needs of all the members in a household.

The state government of Tamilnadu started a scheme called the Makkalai Thedi Maruthuvam, which provides health care services delivered at the doorstep for the elders and chronic patients who need medicines and medical assistance. This is a part of the National Health Mission programme.

To tackle the non communicable diseases in the state and to ensure that the health care services are delivered directly to the beneficiaries at their doorstep, it focusses on the community based interventions to improve compliance and disease control in the state.

The mission director of the national health mission says that the beneficiaries of this scheme will be brought under the population health registry, to ensure continuous monitoring and follow up of patients. The director further states that the home based drug delivery component of the Makkalai Thedi Maruthuvam Scheme is specifically developed to address the basic issues of detecting the diseases and to control the same.

This scheme consists of a team including women health volunteers (WHVs) under the Tamil Nadu Corporation for Development of Women, existing ASHAs in tribal areas, mid level health provides, voluntary health nurses, health inspectors, palliative care nurses, and physiotherapists with the monitoring support of other public health field staff. 

The scheme includes the services to detect and monitor hypertension, diabetes, oral cancer, cervical cancer, breast cancer, TB, leprosy, kidney disease, pulmonary disease and mental health etc.

The Women Health Volunteers (WHVs) Group delivers hypertension and diabetes drugs to registered patients aged above 45 and to also those who have poor mobility and motivates women for cancer screening, and immunisations.

Around 12000 WHVs are working in the state and almost all are appointed by the SHGs. For the WHVs who are working in rural areas, the incentive is Rs 5500 per month; for urban areas the incentive is Rs 3500 per month and it is based on the completion of tasks and targets.  Even in this meagre amount, a substantial amount of the incentive is being taken by the SHGs.

CITU is mobilising and organising the women health volunteers Group. In July 2022, Tamil Nadu state committee of CITU organised a meeting in Trichy and formed a committee to mobilise theSE workers in all the districts. Around 1000 workers took part in the meeting.  The committee formulated a charter of demands and periodical meetings and campaigns were conducted in the state. The main demands include minimum wages, social security benefits, regularising the working conditions, providing travelling charges, providing vehicles to travel to remote distance and reimbursing the actual amount spent for the work.

On January 20, a delegation led by the president of CITU and general secretary and other leaders of the union met the minister of health and submitted the charter of demands. The minister assured the delegation that the government would certainly settle the issues.

And on February 8, a massive demonstration was held in Chennai demanding the above demands to be fulfilled. The demonstration was attended by more than 2600 WHVs from the state. CITU leaders addressed the demonstration. A delegation met the principal secretary, ministry of health and welfare and apprised him of the demands.

A large section of educated women workers working in the State-sponsored schemes are being exploited as a result of the implementation of neoliberal policies. A constant and sustained struggle is needed to stop the exploitation of these scheme workers.