Back ground-Health Extension Program (HEP) is innovative community based program. Thernaim of the program is to improve access to basic essential health service in severely under servedrnrural and remote communities with the goal of achieving universal primary health care. There arernsome studies on HEP; most of them are evaluation of the program and its implementationrnprocess. This study on its side focus on assessing extent of Health Extension Workersrnfunctionality and its determinants again this study is the pioneer to address the issues of HealthrnExtension workers competence.rnObjectives: The study was designed to assess Health extension workers level of functionalityrnand competence on family health package components of health extension program in East Shoarnzone of Oromia region.rnMethodology: A cross sectional study was conducted from January2010 â€“April2010. In thernstudy 381 HEWs were participated in the functionality assessment after this functionalityrnassessment 42 Health Extension Workers were selected by simple random sampling fromrnfunctional HEWs and observed during their performance of Ante natal care(ANC),post natalrncare(PNC) and delivery and new born care to study their competence by using observationalrnchecklist and written examination. Logistic regression was used to identify factors associatedrnwith Health Extension workers functionality.rnResult: Functionality- Overall prevalence of HEWs functionality on family health package wasrn92.9%. 98.2% of HEWs were functional on family planning service while only 43% of them onrndelivery and new born care. Supervision (p-value, 0.015), and refresher training (p-value0.016)rnwas found highly associated factors with functionality of HEWs. In school training on familyrnhealth package lacks both theoretical and practical training.rnCompetence- HEWs were more competent on PNC (78.6%) followed by ANC (76.2%) andrndelivery and new born care (66.7%).HEWs were highly competent on interpersonal and routinernactivity than technical skill during performing the activities. Health Extension Workers (HEWs)rnscored more on theoretical knowledge (written examination) than practical skill (observation) inrncase of ANC& delivery and new born care but in PNC the reverse. Stretcher and examinationrnbeds were found scarce equipment while contraceptives were highly supplied drugs to healthrnposts.rnConclusions and recommendationrnGenerally level of functionality of HEWs were encouraging in all service under family healthrnpackage except delivery service, again competence level of HEWs was satisfactory on ANC andrnPNC but delivery service need especial attention to maximize their competence andrnfunctionality. The program need attention at school training level and also in service refresherrntrainings, on job supervision and timely supply of recommended medical equipments andrnsupplies are mandatory for HEWs functionality and competence.