This study assesses the opportunities and challenges of implementing health extension program in Shiromeda Health Center, Addis Ababa, Ethiopia. It has three key objectives: to examine prospective and retrospective views of health extension workers towards health extension program; determine the challenges faced by clients in their health service utilization and examine the challenges extension workers face during provision of services. The study employed cross sectional research design and qualitative methods. Data were collected from health extension workers and residents using interview and focus group discussions, respectively. Accordingly, while four health extension workers were interviewed, two focus group discussions, each consisting of six discussants, were conducted with members of the community based on the objectives of the study. The study found that health extension program has become a hit- or- miss phenomenon for health extension workers are fed up with the routine, tiresome work of increasing health seeking behavior of people and keeping personal hygiene and environmental health with poor salary and other compensations. Though implementation of health extension program is considered as the right action for Ethiopia, except one, all interviewees have no interest to stay as health extension workers. It is also found that on top of limited number of toilets and other health promoting establishments, politicization of formation and implementation of community based health development army has severely limited the success of health extension program. Therefore, appropriate remuneration for health extension workers; establishment of health promoting infrastructures; deployment of senior and male health professionals as health extension workers should be considered.
Key words: Health extension program, health development army, health extension workers, public health, opportunities, challenges.