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 .
Outcome of screening by clinical examination of the breast in a trial in the Philippines
The value of screening by Clinical Examination of the Breast ( CBE ) as a means of reducing mortality from breast cancer ( BC ) is not established . The issue is relevant , as CBE may be a suitable option for countries in economic transition , where incidence rates are on the increase but limited re sources do not permit screening by mammography . Our aims were to assess whether mass screening by CBE carried out by trained para‐medical personnel is feasible in an urban population of a low‐income country , and its efficacy in reducing BC mortality . Our study was design ed as a r and omised controlled trial of the effect on BC mortality of 5 annual CBE carried out by trained nurses . The target population was women aged 35–64 years , resident in 12 municipalities of the National Capital Region of Manila , Philippines . The units of r and omization were the 202 health centres ( HC ) within the selected municipalities . During 1995 nurses and midwives were recruited and trained in performing CBE . The first round of screening took place in 1996–1997 . The intervention however showed a refractory attitude of the population with respect to clinical follow‐up and was discontinued after the completion of the first screening round . Cases of breast cancer occurring in the study population during 1996–1999 were identified by the 2 local population ‐based registries . In the single screening round 151,168 women were interviewed and offered CBE  , 92 % accepted ( 138,392 ) , 3,479 were detected positive for a lump and referred for diagnosis . Of these only 1220 women ( 35 % ) completed diagnostic follow‐up , whereas 42.4 % actively refused further investigation even with home visits , and 22.5 % were not traced . Of 53 cases that occurred among screen‐positive women in the 2 years after CBE only 34 were diagnosed through the intervention . Eighty cases occurred among screen‐negative women . The test sensitivity  for CBE repeated annually was 53.2 % . The actual sensitivity of the programme was 25.6 % and positive predictive value 1 % . Screen‐detected cases were non‐significantly less advanced than the others . Previous studies have shown that most breast cancer cases in the Philippines present at advanced stages and have an unfavourable outcome . Although CBE undertaken by health workers seems to offer a cost‐effective approach to reducing mortality , the sensitivity of the screening programme in the real context was low . Moreover , in this relatively well‐educated population , cultural and logistic barriers to seeking diagnosis and treatment persist and need to be addressed before any screening programme is introduced . © 2005 Wiley‐Liss ,
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 .