In addition to doubts in the skill of the rural Health Extension Worker (HEW), they are also expected to discharge several additional roles and responsibilities along with maternity related services. Moreover, they are not able and encouraged to attend skilled birth delivery services to mothers, rather they are expected to identify the problem and refer to next higher level health facility which are inaccessible (geographically, socially, economically...etc) to the rural community. This will definitely impend better utilization of modern maternity services.