BMJ Open2018;8:e020423. doi:10.1136/bmjopen-2017-02042 EC has been increasingly used in the evaluation of maternal and child health programmes.12–15 For instance, Nesbitt et al compared crude coverage and EC of pregnant women with facility-based obstetric services in Ghana and estimated that although 68% of the women studied had service access only 18% received high-quality care provided by a skilled birth attendant.16 Similarly, by comparing EC of young children receiving Strengths and limitation of this study. Using multiple data sources (direct observation, vignettes, facility inventories) this study comprehensively assessed under 5-year-old child service performance of first-line health facilities. We conducted this study in around 500 primary-level health facilities and within 7000 households across six regions in Burkina Faso.