Table 1 Key actors and their potential impact on task shifting policy
Actor | Engagement with taskforce | Interest regarding scale up and task shifting policy | Potential support for lay counsellor testing* | Evidence of support or opposition to task shifting |
|---|---|---|---|---|
Ministry of Health (central) | Limited but aware | Use existing salary lines: encourage task shifting | +++ | Agrees to meetings with all players |
Ministry of Health (NACC) | Limited but aware | No significant engagement. Supportive if CBOs and NGOs using lay counsellors | + | National AIDS Strategy sets targets for scale up No significant involvement in the processes |
Ministry of Health (NASCOP) | Convened taskforce in 2001 Host meetings | Open as many sites as possible with wide geographic coverage | ++ | Provides enabling policy environment Open wording to appease all players Accepts variety of financial contributions |
Ministry of Health (provincial and district level) | Occasionally invited to meetings | Ensure quality of sites in districts Pragmatic: work within existing resources Maintain good relationships and a motivated workforce | ++++ | Provides services and input practical advice into policy development Seeks additional donor support |
Laboratory associations | Individuals attend meetings on behalf of other actors (e.g. if working for a donor but also an association member). Not formally engaged in taskforce until 2003 | Maintain quality of tests Maintain professionalism in testing Create jobs for unemployed laboratory technicians and technologists | - | Engages senior Ministry of Health officials and at times national newspapers to try to prevent task shifting |
Counselling associations | Only one (of two possible) counselling associations engaged in taskforce | Recognition for counselling as a profession Maintain quality of counselling Maintain a monopoly on recognised training institutions Continue current curricula on theories of counselling | + | Disagree with length and focus of training curriculum Approach central Ministry of Health directly to request counselling recognised as a cadre in the Ministry |
Donors and their implementing partners | Provided driving force for taskforce establishment, including funds for secretariat | No funding for government salaries: encourage task shifting but varying approaches to incentives for lay counsellors Report high client flow Report high numbers of sites opened | +++ | Funding to government directly to convene taskforce, collect data etc. Influence through support to implementing partners whose remit is policy change Influence through support to NGO/CBOs |