Many countries are adopting user fees as part of their national strategies for financing for public health care. While these fees generate funding, they can also deter poor and vulnerable groups from seeking care in a timely manner. In an effort to protect these groups and allow them fuller access to health care, many countries, including Zambia, have instituted policies to excuse the groups from paying fees. In practice, however, these exemption (for characteristic targeting of groups, based on age, disease, employment, or other characteristics) and waiver (for targeting individuals, based on ability to pay) policies often do not produce the desired results, because they lack clear and consistent procedures for implementation and evaluation, and funding to reimburse providers who provide care to the target population. The current review, done by Partners for Health Reformplus at the request of USAID/Lusaka and the Zambia Integrated Health Program, looks at literature regarding these policies, with a focus on seeking out country-specific examples of individual, need-based waivers. The review found that evaluations that have been done focus on components of the implementation process, rather than on quantitative analysis linking implementation and its effectiveness in reaching the poor. However, some general conclusions and recommendations are supported by the literature: Waivers are most appropriate for higher-cost services. In addition, there must be simple waiver policies and guidelines that are clearly communicated to health care providers and beneficiaries, a funding mechanism to reimburse providers, and a system for monitoring and evaluating the waiver program to ensure it produces the intended outcomes.