This first, extensive, facility-based study of health services utilization in central, southern and western Ethiopia reveals steep distance decay gradients and underutilization of rural health services, the result of numerous geographical, socioeconomic, cultural and facility-based barriers. Out-patient statistics of 280,656 first-visit polyclinic patients in 8 hospitals, 8 health centres and 9 health stations in 7 administrative regions and of 10,885 sick children, 7767 antenatal attendants, 902 family planning acceptors, 275 vaccinated children and mothers and 1066 free patients, as well as in-patient statistics of 11,221 patients in 5 hospitals were analysed to determine catchment areas and utilization rates. On the average, 46% of the polyclinic patients were residents of the same town or village, 39% of the same awraja (district) and 5% of other administrative regions. Sick children, family planning attendants, free patients and in-patients lived relatively nearer to health facilities than polyclinic out-patients. Interviews with polyclinic out-patients showed that type and cost of transportation, type of illness, patient preferences, socioeconomic status of patients and referral patterns were important factors in utilization. Aggregation of all available health services data indicates that whereas some towns approach the targeted 2.5 per capita patient visits per year, coverage of the rural population is relatively low. Suggestions are made on how to overcome the problem of underutilization of rural health stations and to improve the health services information system.