Introduction: The study was undertaken to assess and compare the adherence to IMNCI guidelines among ANMs and ASHA-Sahyoginis in terms of the following five elements of case management process of IMNCI-assessment, classification, treatment, counselling and referrals of sick young infants and children. Methods: Data obtained from 520 IMNCI workers (including 390 ASHA-Sahyoginis and 130 ANMs) working at subcenter / village / anganwadi kendras of the initially and fully IMNCI implemented nine districts of Rajasthan. Multistage (cluster) with stratified proportionate sampling technique was adapted. Direct overt non-participatory observation technique with validated and reliable observation checklists were used to collect data. Results: Findings of the study reveals that 43% and 32% of ANMs showed overall adherence to IMNCI guidelines of young infants and children respectively – whereas only 19% and 3% of ASHA-Sahyoginis showed overall adherence to IMNCI guidelines of young infants and children respectively. Comparative analysis of ANM's and ASHA-Sahyogini's adherence clearly indicated that 43.08% and 31.54% of ANMs showed overall adherence in comparison to 18.72% and 2.56% of ASHA-Sahyogini's overall adherence to IMNCI guidelines for young infants and children respectively. Conclusion: Findings of some previous studies and reports of UNICEF, WHO and Ministry of Health & Family Welfare (MOHFW) Government of India are found to be in line with the current study. The low level of adherence particularly among ASHA-Sahyoginis is because of lack of motivation, monitoring and supervision. Apart from the weak monitoring and supervision, overburden of ANMs with various programmes, maintenance of several types of records and reports serves as a major hindrance in the adherence of ANMs to IMNCI guidelines.