Policy makers in the health sector face a continuous search for optimal methods of financing and funding national health services. In public finance and health care in particular, optimal is often defined in terms of some idea of equity and efficiency. In resource-constrained settings such as Zambia, these challenges take priority status and so policy makers place greater emphasis on questions of how to mobilise additional resources for financing growing health care need. It is in this context that user fees or cost sharing in general has been used as part of revenue mobilisation strategies in Zambia since 1993. In health policy, explicit associations (even direct inferences) are often drawn between how much revenue is raised and how that revenue is raised, and population health outcomes. This is the reason for including explicit equity goals in financing policy. Alongside the revenue objectives, the Zambian financing policy of 1998 made sure that various sections of the population were to be protected from paying user fees through a range of exemptions. As part of the fair financing theme work of the Regional Network for Equity in Health in East and Southern Africa (EQUINET), in conjunction with the Health Economics Unit at the University of Cape Town, this study aimed to assess the impact of the removal of user fees at primary health care level in rural areas of Zambia.