Free health care introduced in Burkina Faso in 2016 aims to replace user fees to improve access to maternal, neonatal and infant (MNCH) care by prepositioning public funds to facilities. The scheme covers all public and some private facilities for a defined set of services for children under five, pregnant and postpartum women without prior registration. The review conducted by ThinkWell and RESADE combined literature review, data analysis and interviews to understand implementation, challenges and lessons. Free care increased service utilization and reduced out-of-pocket payments, but showed no improvement in quality of care. Insufficient funding in 2018-2019 created gaps between invoices and payments, and increased debts to the CAMEG central purchasing agency. Fee-for-service payment promotes equity and perceived quality, but can increase expenditure and pose administrative tensions; signs of an increase in the average cost per invoice have been observed. Payment delays and shortfalls have reduced the autonomy of facilities and generated dissatisfaction among providers. Outsourced validation mechanisms enabled most invoices to be verified, but expired contracts weakened control. The recommendations focus on adequate budget allocation, the link between free services and quality, and the examination of alternative payment mechanisms such as lump-sum payments, taking care to preserve quality. The document also stresses the need for transparent communication on payments and how they work.