The paper presents a detailed review of the Gratuité policy launched in Burkina Faso in 2016, which abolishes fee-for-service payments for women and children under five. Gratuité funds a defined basket of maternal, neonatal and pediatric services via quarterly prepositioned transfers to special district and hospital accounts, with the majority of funds earmarked for the purchase of medicines by the central depository CAMEG. The authors analyze data from the e-Gratuité platform, activity reports, NGO audits and interviews with central and local players. The findings show a clear increase in the use of services for children and initial gains in reducing direct household expenditure, but an upturn in out-of-pocket payments in 2018 linked to payment interruptions. Since mid-2018 underfunding has created gaps between invoices and payments, causing growing debt to CAMEG and supply problems. The fee-for-service payment mechanism was chosen for its perceived fairness, but it poses risks of cost inflation and an administrative burden for centers. External controls validate on average 90% of claims, but contract shortages have reduced oversight. The main recommendations are to ensure a sufficient budget allocation, to consider simplifying payments (case-based tariffs) while linking payments to quality criteria, and to improve coherence with other mechanisms such as PBF and CNAMU. The report also proposes greater financial transparency.