Background: The Health Extension Program (HEP) in Ethiopia is a core component of thernbroader health system and is one of the strategies implemented with a view to achievingrnuniversal coverage of primary health care to the rural population within the context of limitedrnresources. There is scanty evidence on factors influencing motivation of health extensionrnworkers (HEWs) in Ethiopia. This study aimed to explore factors affecting motivation of ruralrnHEWs.rnMethods: A qualitative case study design was used. In depth interview data collection methodsrncarried out for comprehensive understanding of factors affecting motivation among rural HEWs.rnHEWs working in rural areas are the primary study population. Two districts were selected fromrnOromia and SNNPR based on accessibility to carry out the research. Sixteen study respondentsrn(no refusal) were sampled considering a wide range of variation in multiple aspects of HEWsrnlike service year, marital status and career level (level III and level IV). The principalrninvestigator collected all data. All interviews were recorded, transcribed, translated, coded andrnthematically analyzed based on similarities, differences, and associations. Atlas.ti (v 7.5.7) wasrnused to analyze the data. Quality assurance of the study was considered from selection of studyrndesign to data analysis and report writing.rnResult: Factors affecting motivation HEWs were identified at the individual, family, community,rnand organizational/system levels. Love of work and pride to serve community is personal levelrnmotivators. However, workload and burnout were among de-motivating factors at individualrnlevel. Moral and domestic work supports are main family level source of HEWsâ€™ motivation. Atrncommunity level, increased respect, acceptance and task sharing motivated HEWs. On therncontrary, less acceptability of health service by the community de-motivated HEWs. Slowrnprogress in career advancement; poor supervision, support and governance from leaders,rninadequate material availability, no transfer policy, insufficient financial earning were labeled asrnde-motivating factor at health system/organizational level. Among the motivating factors atrnorganizational level, regular supportive supervision by health center, availability of supplies andrnon the job trainings were identified.rnConclusions: Workload, remuneration, career advancement, transfer policy and leadershiprnsupport require more attention. Functional linkage with health center, regular training andrncommunity engagement are essential to maintain level of motivation.