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Background: Implementation of waivers and exemptions from user charges in health services are usually very hard to implement in those countries that have adopted them. Poor means testing mechanisms for proper targeting have been the main reasons for this problem. Objective: To describe the practice of providing free health care in Bahir Dar area (northern Ethiopia) and to assess the presence and extent of under-coverage and leakage in the waiver and exemption systems. Methods: A cross sectional descriptive study was conducted between May and July 1999 in Bahir Dar area to compare the demographic and socio-economic characteristics of free patients with those paying at the analysis stage using data from household and facility exit interview surveys. In addition, discussions with community leaders, health facility staff and review of health facility records were made. Results: More than half (52.4%) of the 210 respondents for the public facility exit survey in the study area were found to be free patients. There was no statistically significant association between low income and getting free care among rural household survey respondents in the area. Lack of proper documentation of waivers and exemptions was also observed in rural areas and at lower level health facilities Conclusion: There are indications for a need to revise the current criteria for granting waivers so that a better mechanism for means testing is developed. In addition, mechanisms should be established to ensure the implementation of waivers and exemptions in a properly documented manner. [Ethiop. J. Health Dev. 2002;16(2):173-182]

Assessment of the Free Health Care Provision System in Bahir Dar Area, northern Ethiopia