Ethiopia’s Health Extension Program is an innovative community-based health care service delivery system that emphasizes the construction of health posts at village level and assignment of trained Health Extension Workersto improve the prevailing high disease burden and mortality that Ethiopians suffer from. The main objective of the study was to assess the socio-cultural factors that affect the implementation of HEP in rural communities focusing on Family Health and Hygiene and Environmental sanitation packages of HEP. A cross sectional survey was conducted in randomly selected 416 households of rural kebeles found in Jimma Zone. Even though 57% of the mothers did ANC follow-up in health posts, none of them reported for delivery in health posts. Home delivery was practiced by 82.5% of the mothers. From the 61.5% FP service beneficiaries only 15% were clients of health posts. TT coverage was 90% and 87% of the under 5 children have vaccination cards. Though 90% of the households have constructed pit latrines, 49% lackedshading and 10% have practiced open field defecation. Wash-hand basin and soap or mud was not seen around 95% of the latrines. Unprotected streams were sources of water supply for about 10% of the households. Almost half of the households studied disposed solid wastes in open fields. Generally, health posts were underutilized by the community. Above all, attention was not given to the cultural assets of the community that are suggested in the HEP guidelines as a means to increase community’s participation. Key words: Health extension programs, innovative and Socio-cultural factors.