This report is an evaluation of the Community Health Welfare Scheme (CHEWS) pilot implemented in Kafue, Zambia, from 2002 to 2004. The goal of CHEWS is to increase health care services utilization by the most vulnerable populations through the provision of a user fee voucher. The identification of beneficiaries and allocation of vouchers is done by a community-based institution (the community welfare assistance committees, CWAC) using a criteria matrix for identification. This evaluation report is based on a household survey of CHEWS and non-CHEWS households, and focus group discussions of health providers and CWACS members. The results show that there were no differences in health seeking behavior and in health status in CHEWS and non- CHEWS households, leading to the conclusion that the targeting matrix was not used correctly or was too complex to use at all. However, the evaluation did find that there was increased collaboration between the Ministry of Community Development and Ministry of Health and that health center personnel were attending to voucher clients without prejudice. It is posited that the inability or unwillingness to use the targeting criteria is a result of the complexity of the matrix, the difficulty of identifying and selecting the poorest in a generally poor population, and the lack of resources for support/supervision. It is recommended that the matrix and its use be reviewed and field-tested to improve upon it. Finally, an exemption mechanism needs adequate funding to function correctly; it cannot be implemented without appropriate investments.