Objectives: The study sought to document the experiences of providers and beneficiaries regarding access to essential medicines following introduction of user fees in the pediatric unit of a public hospital. Methodology: The study is qualitative. Data was collected using purposive sampling for facility managers and convenient sampling for caretakers. Only caretakers who consented were interviewed. Data were collected using in-depth interview guides as the main tool. A pilot study was conducted to assess the reliability of the study tool. The data was analysed guided by predetermined themes. Results: The introduction of the user fees for pediatric medicines under a devolved governance system was to supplement the allocations given by the national government. The user fees seemed to have increased revenue for buying more drugs and non-pharmaceutical items and to subsidize prices for medications that were previously not available due to little resources. The management indicated that there was increased availability of drugs due to the higher allocation of resources and that more drugs had been procured to meet patient needs. Immediately after introduction of user fees, there was a drop in utilization, but with time there was an increase in uptake due to increased availability of drugs. There is need for the management of hospital to ensure that there are enough health workers in the hospital to meet the needs of increasing number of patients utilizing pediatric services after introduction of user fees. Conclusion:Although the user fees seemed to have improved access to pediatric services, there is always need for caution as user fees are known to be an important barrier to use of health services especially by low-income groups. Importantly, implementation of user fees should go hand-in-hand with improved services.