A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial

Authors: Norris, Shane A., Soepnel, Larske M., Mabetha, Khuthala, Motlhatlhedi, Molebogeng, Nkosi, Nokuthula, Lye, Stephen, Draper, Catherine E.

Community health workers (CHWs) are vital in improving health in low- and middle-income countries like South Africa. The Bukhali project, a trial aimed at supporting young women in Soweto, involves CHWs delivering preconception and pregnancy care. This study explored the challenges and successes of implementing Bukhali from the CHWs’ perspectives. Through focus group discussions with 13 CHWs, six key factors were identified: interaction with public healthcare, health perceptions, language barriers, socioeconomic constraints, community views, and the CHW-participant relationship. The CHWs used various tools to overcome challenges, with trust between CHWs and participants being crucial. Recommendations include better follow-up on referrals, continued training, and addressing health-related stigma. These insights are valuable for improving similar programs and strengthening CHW roles.