Ethiopia has one of the worst health outcomes in the world. A new health policy resulted in some improvements in the populations health and there have been critical changes in the financing structure of healthcare. However, user fees for healthcare remain an important element of healthcare financing. This study explored perceptions, attitudes and experiences with user fees at public health facilities among poor households. The objectives were to investigate (1) how poor households experience user fees at public health facilities and (2) how user fees influence health-seeking behaviours of poor household members. The study found that user fees can present a substantial psychological and financial burden and are one of the barriers to healthcare use, especially for poor households. The findings suggest that pre-payment and risk-sharing mechanisms such as the traditional Eders or health tax might be to user fees and protect against impoverishment in case of major health events.