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

*+indicates support of lay counsellor testing and - indicates lack of support