I would like to express my gratitude to Bahrdar University College of Medicine and Health Science School of Public Health Department of Health System Management and Health Economics for granting ethical clearance and designating advisors for this thesiswork. I would like express my gratitude and appreciation to my esteemed advisors, Desta Debalkie and Ayinengda Adamu for their un reserved support, guidance and encouragement For granting permission to conduct the study and for giving the crucial introductory data, I would like to thank west Gojjam zone health department and Finoteselam town for their permission and respondents of this thesis work for their conscent. Last but not least,. I also like to thank