This research will examine the variation in the utilisation of curative healthcare services for children under five years using health system characteristics to understand the contextual and health system factors contributing to such patterns. The objective is to identify sub-national hot-spots with low healthcare utilisation rates after the implementation of the Free Health Care Initiative in Sierra Leone in 2010, together with potential socio-demographic and health system related drivers. This can guide strategies for improving child healthcare services and thus improve child survival.