<p>To reduce child mortality in children younger than 5 years, Burkina Faso has been offering free care to this population of children since 2016. The free care program is aligned with the Integrated Management of Childhood Illness (IMCI) guidelines. Given that the number of studies that evaluated the competences of health-care workers (HCWs) in the care of under five children during the free care program was limited, we assessed the adherence level of HCWs to the IMCI guidelines in the context of free care.</p>