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 .
Cost-effectiveness of oral cancer screening: results from a cluster randomized controlled trial in India.
OBJECTIVE To evaluate  oral cancer screening by visual inspection . METHODS A cluster r and omized controlled trial was initiated in Triv and rum district , Kerala , India . Of 13 population clusters , seven were r and omly allocated to three rounds of screening between 1996 and 2004 , while st and ard care  was provided in six ( control arm ) . An activity-based approach was employed to calculate costs associated with various components of the screening trial . Information on the re sources used and on clinical events in each trial arm was derived from trial data bases . Total costs for each cluster were estimated in 2004 United States dollars ( US$ ) . The incremental cost per life-year saved was calculated for all eligible individuals and for high-risk individuals ( i.e. tobacco or alcohol users ) . FINDINGS The proportion of oral cancers detected at an early stage ( i.e. stage I or II ) was higher in the intervention arm than the control arm ( 42 % versus 24 % , respectively ) . The incremental cost per life-year saved was US$ 835 for all individuals eligible for screening and US$ 156 for high-risk individuals . Oral cancer screening  by  visual inspection  was performed for under US$ 6 per person . CONCLUSION The most cost-effective approach to oral cancer screening by visual inspection is to offer it to the high-risk population . Targeted screening of this group will ensure that screening can be offered at a reasonable cost in a limited-re source setting
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 .