Background: Availing equitable and affordable health services for citizens is becoming a problem for governments of developing countries. In Ethiopia, the government has been implementing fee waiver scheme since 1998 to advance the health access by the poor, though it is still a crucial challenge of the health sector. Purpose: The intent of the study was to evaluate the effectiveness of fee waiver scheme in improving access to health by the poor in Addis Ababa and to propose implementation framework to improve its outcome. Method: This study employed qualitative research approach to evaluate the program effectiveness and to propose implementation framework in two phases. Exploratory and descriptive case study designs, and Delphi techniques were utilized to evaluate the scheme’s effectiveness and to validate the proposed implementation framework. The researcher employed purposive and convenience sampling methods to sample the study populations, and used Atlas ti 7.5 software to analyze the findings. Result: This study revealed that the commencement of the scheme has benefited considerable poor population in the city. However, its effectiveness in terms of addressing the needy population, services coverage and protecting the poor from financial hardship is not yet achieved. Poor health facilities capacity, poor program management and lack of comprehensive monitoring and accountability system were found major factors that affected its success. As a result, the researcher proposed an implementation framework with the aim of addressing these problems. Conclusion: Achieving Universal Health Coverage without addressing the indigents’ health need is impossible. Lack of comprehensive health services, in adequate population coverage and poor financial protection were among the major findings. Hence, prior attentions should be given to equip health facilities with necessary infrastructures and ensure the inclusion of all needy populations through effective monitoring, governance and leadership mechanisms to improve its intended outcomes. If utilized properly, the findings and the implementation framework of this study will serve as valuable resources for immediate decisions and directions by the policy makers / Health Studies / D. Litt. et Phil. (Health Studies)