Out-of-pocket expenditure for infant healthcare remains a major challenge in low- and middle-income countries despite the expansion of publicly funded maternal and child health programs. This community-based cross-sectional study assessed the magnitude of out-of-pocket expenditure incurred by caregivers of sick infants and evaluated maternal awareness of child health programs in selected urban slum and rural areas of Odisha, India. Data were collected from 275 caregivers of infants who had experienced illness within three months prior to the survey using a structured questionnaire. Descriptive analysis showed that nearly all caregivers incurred out-of-pocket expenditure even when services were sought from government facilities, a finding consistent with earlier Indian studies. The mean expenditure per illness episode was approximately INR 947, with medicines, transport, and diagnostics being the main contributors. Fever and diarrheal illnesses were the most commonly reported conditions, reflecting national morbidity patterns. Awareness of Janani Shishu Suraksha Karyakram and Janani Suraksha Yojana was moderate, while knowledge of Home-Based Neonatal Care and Integrated Management of Neonatal and Childhood Illness remained low. The findings indicate persistent financial burden and gaps in program awareness, highlighting the need for improved implementation of free entitlement schemes and strengthened community-level health education. .