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Health Extension Program (HEP) in Ethiopia was introduced to provide a quality package of health services at the community level, including better health care to women and children, especially in the most rural and remote communities. Sub-Saharan Africa accounted for 62 percent of global maternal deaths; Ethiopia's Maternal Mortality Ratio (MMR) estimated 420 maternal deaths per 100,000 live births, with a lifetime risk of maternal death one in 52. Accordingly, this study examines the challenges and opportunities of institutional delivery by health extension workers Bure, Gojjam. The researchers employed a Mixed-Method research approach to investigate the Challenges and opportunities of institutional delivery posed by health extension workers. The quantitative data were analyzed using descriptive statistics, while the qualitative data were analyzed using thematic analysis. The study finding disclosed that the community and women's perception were significant challenges of institutional delivery closely connected with informants' traditional beliefs and newly acquired knowledge, low level of education, and less contact of health extension workers and community. However, health extension workers contribute to community health promotion by conducting home visits surveys and maternal health education sessions to advise different places through the family organization. The research finding revealed that the need for health extension workers and other community stakeholders has to be equipped with communication skills, mobilization skills, and commitment to the work. So, continuous training has to be given on competency and communication skills to update and increase health extension workers' knowledge of health promotion in general and maternity services.
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