1Tigray Public Health Institute, Mekelle, Ethiopia; 2Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 4Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany Correspondence: Getasew Amare P.O. Box – 196, Gondar, Ethiopia Tel +251910151944 Background: Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. Methods: A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU.