household health careseeking costs experiences from a randomized controlled trial of communitybased malaria and pneumonia treatment among underfives in eastern uganda background home and communitybased combined treatment of malaria and pneumonia has been promoted in uganda since mid 2011 the combined treatment is justified given the considerable overlap between the symptoms of malaria and pneumonia among infants there is limited evidence about the extent to which communitybased care reduces healthcareseeking costs at the household level in rural and urban settings this paper assesses the ruralurban differences in direct and indirect costs of seeking care from formal health facilities compared to community medicine distributors cmdsmethods exit interviews were conducted for 282 159 rural and 123 urban caregivers of children below five years who had received treatment for feverrelated illnesses at selected health centres in iganga and mayuge districts data on the direct and indirect costs incurred while seeking care at the health centre visited were obtained using another tool household level direct and indirect costs of seeking care from cmds were collected from a total of 470 caregivers 304 rural and 166 urban costs incurred at health facilities were then compared with costs of seeking care from cmdsresults household direct costs of seeking care from health facilities were significantly higher for urbanbased caregivers than the rural median costus042 for urban and zero for rural p00001 the same is true for seeking care from cmds p00038 overall caregivers travelled for an average of 75 min to reach health centres and spent an average of 80 min at the health centre while receiving treatment however households in rural areas travelled for a significantly longer time p0001 to reach health care facilities than the urbanbased caregivers besides travelling longer distances rural caregivers spent 150 min seeking care from health facilities compared to 30 min from cmdsconclusion time and monetary savings for seeking care from cmds are significantly larger for rural than urban households thus home and communitybased treatment of child febrile illnesses is much more costsaving for rural poor communities who would spend more time travelling to health facilities which time could be redirected to productive and incomegenerating activities