Home programmes are a core component of early childhood intervention, where speech-language therapists provide take-home, structured activities for caregivers to support children's speech-language development between sessions. Limited research exists on home programmes within South Africa's public healthcare system, where resources and access challenges impact delivery. This study explored caregiver perceptions on the usefulness and challenges of these programmes in a South African public healthcare context. A descriptive cross-sectional survey was conducted with 60 purposively selected caregivers of children aged 0–6 years attending speech-language therapy at public clinics. Data was collected via a structured questionnaire. Descriptive and non-parametric inferential statistics were used to analyse quantitative data on demographics, therapy history, home programme experiences and environmental factors. Open-ended responses were examined quantitatively through frequency analysis to highlight common responses. While 46.7% of participants rated home programmes as ‘extremely helpful and exceeding expectations’, 51.7% reported challenges, including limited time, unconducive home environments, limited finances and unclear instructions. The reported benefits of home programmes clustered around several themes. Caregivers most frequently identified increased opportunities for practice at home, alongside improved confidence in their ability to support their children. Many also highlighted visible progress in their children's development as a key benefit. Practical elements were particularly valued, with caregivers emphasising the usefulness of clear and simple instructions as well as activities that could be carried out using common household items. Findings support the development of contextually responsive, flexible, low-cost home programmes that are integrated into daily routines, particularly in socio-economically diverse, multilingual settings. Further research is needed to explore strategies across broader populations and settings.