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 .
Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial
BACKGROUND Oral cancer is common in men from developing countries , and is increased by tobacco and alcohol use . We aim ed to assess the effect of visual screening on oral cancer mortality in a cluster-r and omised controlled trial in India . METHODS Of the 13 clusters chosen for the study , seven were r and omised to three rounds of oral visual inspection by trained health workers  at 3-year intervals and six to a control group during 1996 - 2004 , in Triv and rum district , Kerala , India . Healthy participants aged 35 years and older were eligible for the study . Screen-positive people were referred for clinical examination by doctors , biopsy , and treatment . Outcome measures were survival , case fatality , and oral cancer mortality . Oral cancer mortality in the study groups was analysed and compared by use of cluster analysis . Analysis was by intention to treat . FINDINGS Of the 96,517 eligible participants in the intervention group , 87,655 ( 91 % ) were screened at least once , 53,312 ( 55 % ) twice , and 29,102 ( 30 % ) three times . Of the 5145 individuals who screened positive , 3218 ( 63 % ) complied with referral . 95,356 eligible participants in the control group received st and ard care . 205 oral cancer cases and 77 oral cancer deaths were recorded in the intervention group compared with 158 cases and 87 deaths in the control group ( mortality rate ratio 0.79 [ 95 % CI 0.51 - 1.22 ] ) . 70 oral cancer deaths took place in users of tobacco or alcohol , or both , in the intervention group , compared with 85 in controls ( 0.66 [ 0.45 - 0.95 ] ) . The mortality rate ratio was 0.57 ( 0.35 - 0.93 ) in male tobacco or alcohol users and 0.78 ( 0.43 - 1.42 ) in female users . INTERPRETATION : Oral visual screening can reduce mortality in high-risk individuals and has the potential of preventing at least 37,000 oral cancer deaths worldwide
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 .