The majority of studies showed improved health outcomes when compared with usual healthcare , including reductions in blood pressure , increased uptake of medications and lower depression scores .
Factors such as training of NPHWs , provision of algorithms and protocol s for screening , treatment and drug titration were the main enablers of the task-shifting intervention .
The main barriers identified were restrictions on prescribing medications and availability of medicines .
CONCLUSIONS Task-shifting from physicians to NPHWs , if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs .
BACKGROUND One potential solution to limited healthcare access in low and middle income countries ( LMIC ) is task-shifting- the training of  non-physician healthcare workers ( NPHWs ) to perform tasks traditionally undertaken by physicians .
The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease ( NCD ) in LMIC .
A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening.
Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries . In May 1998 , supported by a grant from the NCI ( US ) , the Tata Memorial Hospital , Mumbai , India , started a cluster-r and omized , controlled , screening-trial for cervix and breast cancer using trained primary health workers to provide health-education , visual-inspection of cervix ( with 4 % acetic acid-VIA ) and clinical breast examination ( CBE ) in the screening arm , and only health education in the control arm . Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers . The methodology and interim results after three rounds of screening are presented here . Good r and omization was achieved between the screening ( n = 75360 ) and control arms ( n = 76178 ) . In the screening arm we see : High screening participation rates ; Low attrition ; Good compliance to diagnostic confirmation ; Significant downstaging ; Excellent treatment completion rate ; Improving case fatality ratios . The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion , language , age , education , occupation , income and health-seeking behavior for gynecological and breast-related complaints . During the same period , in the control arm we see excellent participation rate for health education ; Low attrition and a good number of symptomatic referrals for both cervix and breast
The majority of studies showed improved health outcomes when compared with usual healthcare , including reductions in blood pressure , increased uptake of medications and lower depression scores .
Factors such as training of NPHWs , provision of algorithms and protocol s for screening , treatment and drug titration were the main enablers of the task-shifting intervention .
The main barriers identified were restrictions on prescribing medications and availability of medicines .
CONCLUSIONS Task-shifting from physicians to NPHWs , if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs .
BACKGROUND One potential solution to limited healthcare access in low and middle income countries ( LMIC ) is task-shifting- the training of  non-physician healthcare workers ( NPHWs ) to perform tasks traditionally undertaken by physicians .
The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease ( NCD ) in LMIC .