Task sharing for point-of-care testing: Review of national health policies and implementation landscape in 19 African countries

The World Health Organization recommends task sharing (TS) for
point-of-care testing (POCT) with lay health workers (LHW) to improve
access when professional capacity is limited. Despite the many benefits of
POCT, TS remains underutilized. This study examined national policies and
the implementation landscape for TS of POCT with LHW in 19 African
countries. We conducted a mixed-methods study from November 2024
to March 2025 using an online cross-sectional survey with stakeholders
from national ministries of health, medical associations, private
laboratories, implementation supporting partners, and LHWs. We also
conducted a document review of national health strategic and policy
documents, as well as key informant interviews (KII) with national
laboratory directors. Participants were recruited via standardized emails,
whilst documents were obtained through direct requests and online
searches. Quantitative data were analysed descriptively, and framework
analysis was used for the qualitative analysis of KII data. Of
217 policy documents collected, 197 (91%) were deemed relevant. Over half
of national health strategic plans (10/19; 53%) recognize LHWs as vital
for expansion of primary healthcare services, but fewer (7/19; 37%)
mention TS. While 58% (11/19) of national laboratory strategic plans aimed
to expand POCT access and quality in facilities with or without
laboratories, 84% did not mention LHW to support TS. Among national
HIV/AIDS strategic plans, 53% (9/17) referenced TS for POCT, mainly for
HIV diagnosis; with only one addressing POCT for advanced HIV disease.
Outside HIV and malaria, LHW POCT was rarely emphasised in policies or
other disease-specific strategic plans. Seventy-five stakeholders
(67% male) from 19 countries completed the online survey, and six KII were
conducted. All reported that LHWs conduct POCT in disease programs, mainly
with donor support. HIV rapid testing was cited as having the most
structured training program. National laboratory leaders
acknowledged implementation challenges but saw opportunities to expand lay
provider POCT. While many African countries have adopted TS for POCT to
LHW, challenges remain. Shifting from fragmented, disease-specific
approaches to an integrated, health system-wide TS model is crucial for
sustainable and equitable POCT. Coherent policy and implementation
reforms, including user-training, fair remuneration, as well as governance
frameworks, are needed to institutionalize TS amid declining resources and
rising testing demands. National laboratory leadership should drive the
adoption of training and quality assurance for task-shared multi-disease
POCT with LHW.