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.