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Background: This study aims to assess the mandatory practical skills of caregivers towards implementation of the Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy in primary health care (PHC) centers of Salah al-Din governorate in Iraq.  Methods: A cross-sectional comparative study was conducted from January to May 2014. An equal sample of 42 trained and 42 non-trained caregivers who are working in 20 PHC centers in Tikrit city and other districts of Salah al-Din governorate of Iraq were included. The study tool was semi-structured questionnaire with 20 questions covering different required practical skills that caregivers should have. The total score was 100 and in a range of 4-6 points for each question. An independent sample t-test was used to compare means of numerical variables. Results: The mean age of total respondents was (33.18 SD 5.82Years) and the vast majority 63 (75%) were females. More than two third 58(69.0%) were paramedical compared to 26 (31.0%) who were doctors. Trained caregivers had statistically significant better practice (73.48 SD 13.46) compared to non- trained caregivers (63.95 SD 17.44). Trained doctors had statistically significant better practice (88.15 ± 2.70) compared to trained paramedical staff (66.90 ± 10.84). Trained caregivers from Tikrit city had statistically significantly better practice (80.26 SD 7.38) compared to trained caregivers from districts (67.89SD 14.85). The highest proportion (97.5%) of trained caregivers felt the child for fever or body hotness properly and the lowest proportion (59.5%) of them recorded age, height and weight correctly. Conclusions: This study showed that training has a positive influence on the implementation of IMNCI interventions. IMNCI-trained caregivers were more likely to correctly classify illnesses than non-trained caregivers.