Though the program has addressed majority of the health problems at grass root level, maternal and child morbidity/ mortality rates of the nation is still one of the highest in the world. This is mainly attributable to the competency level of the rural health extension workers to provide cross-cutting maternity services on top of the deep rooted cultural, social and economic problems of the rural community. For example, a recent study in Tigray Region of Ethiopia showed that even if the HEWs have contributed substantially to the improvement in women's utilization of family Planning (FP), ANC and HIV testing, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant.