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 .
Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months
This paper has been corrected post-publication in deviation from print and in accordance with a correction printed in the February 2012 issue of the Journal . Background Depressive and anxiety disorders ( common mental disorders ) are the most common psychiatric condition encountered in primary healthcare . Aims To test the effectiveness of an intervention led by lay health counsellors in primary care setting s ( the MANAS intervention ) to improve the outcomes of people with common mental disorders . Method Twenty-four primary care facilities ( 12 public , 12 private ) in Goa ( India ) were r and omised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders . Participants were assessed at 2 , 6 and 12 months for presence of ICD-10 common mental disorders , the severity of symptoms of depression and anxiety , suicidal behaviour and disability levels . All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design . The trial has been registered with clinical trials.gov ( NCT00446407 ) . Results A total of 2796 participants were recruited . In public facilities , the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes . There was a 30 % decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses ( risk ratio ( RR ) = 0.70 , 95 % CI 0.53–0.92 ) ; and a similar effect among the subgroup of participants with depression ( RR = 0.76 , 95 % CI 0.59–0.98 ) . Suicide attempts/plans showed a 36 % reduction over 12 months ( RR = 0.64 , 95 % CI 0.42–0.98 ) among baseline ICD-10 cases . Strong effects were observed on days out of work and psychological morbidity , and modest effects on overall disability . In contrast , there was little evidence of impact of the intervention on any outcome among participants attending private facilities . Conclusions Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders , suicidal behaviour , psychological morbidity and disability days among those attending public primary care facilities
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 .