The objective of this study is to evaluate the achievement of the prevent mother-to-child transmission (PMTCT) program and to describe the strategic challenges of its implementation in the the Oromia region, Ethiopia. PMTCT program reports were collected over a period of 12 months from 25 zones of Oromia region. The health facilities in these zones include 28 hospitals and 84 health centers. The reports were analyzed with regard to international and national policies, guidelines, and priorities. Meanwhile, in-depth interviews were conducted with key informants from the government and an nongovernmental organization (NGO). The reports showed that 72 277 (47%) pregnant women who attended antenatal care were tested for HIV. Although 1461 (65%) HIV-positive women walked away without intervention, 1579 (71%) babies born to HIV-positive mothers did not access prophylactic medicine. Interviews with key informants revealed that stakeholders' inertia to coordinated action, disconnect between the regional office and service providers at the grassroots, and an unclear national policy on HIV were major challenges to the program. Addressing policy issues and setting clear purposes for all partners need a committed local leadership and program ownership at regional and federal levels.
