Volunteering and trust-building in maternal health: community health workers’ role in Paucará, Peru

Abstract Background Community Health Workers (CHWs) are crucial to improving access to maternal care in Peru, especially in rural and indigenous communities. Peru's Law N° 30825 formally acknowledges CHWs, but their work is voluntary without employment rights. The impact of this volunteer nature on the trust-building process is unclear. We aim to explore how CHWs facilitate maternal health service utilization in a rural setting, focusing on trust and the implications of their voluntary status. Methods This qualitative study was conducted in January 2025 in Paucará, a rural and predominantly Indigenous district in Huancavelica, Peru. It involved semi-structured telephone interviews with 11 CHWs from the local primary health center. Participants were selected using theoretical saturation sampling, and data were analyzed using Braun and Clarke's thematic analysis. The study was approved by the institutional Research Ethics Committee (N.157/2024). Results All interviewed CHWs reported strong community trust built over years of service. Even though they do not have formal education, they collaborate with health personnel to help women overcome barriers such as distance, language, and traditions through home visits, follow-ups, and promoting culturally sensitive practices. Many CHWs noted that their work often conflicts with their primary livelihoods in agriculture and livestock. Despite the desire for financial compensation, they feared it could weaken the trust they had built, as their work might be perceived as transactional rather than moral and community-driven. Conclusions CHWs in Paucará act as trust-based bridges between rural communities and the health system, addressing barriers to maternal health service utilization. While legally recognized, the lack of financial support threatens the sustainability of their work. Strengthening financial support for CHWs - without compromising community trust - may be a critical policy step to improve maternal care in rural areas. Key messages • CHWs in rural Peru are volunteers who improve maternal care provision through trust-building. • Policymakers must balance CHWs’ financial recognition with preserving their trust-based role.