Assessment of utilization of health care services and the associated factors among adult fee-waiver beneficiaries in Hawassa, southern Ethiopia: A community based cross sectional study

BACKGROUND: Over the past decades, developing countries like Ethiopia have resorted to the implementation of user fees in public health care systems. Nonetheless, evidences suggest that user fees affect the poor negatively. Therefore, Ethiopian government introduced fee-waiver mechanism in 1998 aiming to mitigate the financial constraints faced by the poorest segment of the population in utilizing health care services. Yet, in the country, there is limited evidence on this subject. OBJECTIVE: The overall objective of the study was to assess health care utilization and the associated factors among the fee-waiver beneficiaries in Hawassa City of Southern Ethiopia. METHODOLOGY: A quantitative, cross-sectional study design was employed using a sample of 636 fee-waiver beneficiaries. Data was collected using a structured interviewer-administered questionnaire and analyzed using binary logistic regression. An odds ratio with the corresponding CI was used to identify the associated factors, while P < 0.05 was used to declare significance. RESULTS: The response rate to the survey is 581(91.4%). Of this, 377 (65%) utilized health services in the preceding 3 months of data collection. Availability of medical equipment [AOR = 1.501; 95% C.I. (1.066–2.114)], being >50 years of age [AOR = 2.271; 95% C.I. (1.304–3.953)], improved drug availability in the health care facilities [AOR = 1.682; 95% C.I. (1.118–2.530)] and beneficiaries’ perception of health worker’s handling practice [AOR = 3.759; 95% C.I. (1.425–9.912)] were among the significant factors associated with beneficiaries’ utilization of health care services at public health facilities. CONCLUSION AND RECOMMENDATION: The overall fee waiver beneficiaries’ health care utilizations rate is 64.9%. Optimizing availability of medical equipment, enhancing drug availability and strengthening good patient handling practices are recommended.