Introduction: The introduction of user fees for health care in low income countries often try to remedy inequalities in healthcare utilization by putting in place safety nets in the form of exemptions and waivers. Examining the performance of such mechanisms contributes to understanding the efforts of closing the gap between the haves and the have-nots in the use of health services. Methods: Community based cross-sectional study was conducted in 633 randomly selected households in five districts of Gamo Gofa Zone (an administrative structure between region and district). Data collected using an interviewer-administered questionnaire developed after reviewing relevant literatures; especially South Nations, Nationalities and peoples’ regional health bureau, health care financing check-list. Multivariable logistic regression analysis was performed. P-value less than 0.05 and 95% confidence intervals were used to determine association between dependent and independent variables. Results: More than half (59.6%) of fee-waiver-certified households have utilized health service from government health service organizations. Shortage of drugs and procedures (therapeutic and diagnostic) at the public health facility [AOR=2.58 (95% CI: 1.18, 5.63)], referral to a higher level [AOR=5.95, 95% CI: 2.63, 13.46] and households cost of transportation and other non-medical costs [AOR=5.27 (95% CI: 2.33-11.95)] and were significantly associated with not utilizing health services’ by those households included in user fee payment waiver scheme. Conclusion: More than one third of the beneficiaries did not utilize their exemption for health services use in public health facilities. They fail to use this opportunity as a result of shortage of drugs and procedures in public health facility, challenge of high non-medical costs, and limited applicability of poverty certificate.
Tegegn Chote, Kora Tushune, Kiddus Yitbarek, Mirkuzie Woldie
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