South Africa has <span class="attribute-to-highlight medbox">a</span> long history of community health workers (CHWs). It has been <span class="attribute-to-highlight medbox">a</span> journey that has required balancing constrained resources and competing priorities. CHWs form <span class="attribute-to-highlight medbox">a</span> bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’<span class="attribute-to-highlight medbox">s</span> Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning.