These days, health is taken to be the product of the individual’s continuous interaction and interdependence with her/his ecosphere. Based on this belief, enabling people to increase control over and improve their health has been considerably given attention in health policies. This study is, therefore, primarily focused on the application of health communication in urban sanitation. The study was employed qualitative research method dominantly with case study design. The populations of the study for the qualitative method are all health extension workers and their supervisors that are found in the two sub-cities as well as the only health officer at the city health department. Also, 176 model households were taken as a sample for the qualitative part in the two sub-cities and 159 model households were participated in this study. Sample selection was done through purposive and simple random sampling techniques and data collection tools were in-depth interview, document analysis, observation and questionnaire. The qualitative data was analyzed thematically while the quantitative was analyzed by using statistical package software for social sciences (SPSS) Version 22.0 with descriptive statistic. The study was used participatory communication, persuasion communication, and social learning theories as well as social and behavioral change communication (SBCC) model as frameworks of communication. The result of the study shows that the presence of practicing non- participatory top down approach of communication, absence of health education, attitudinal and behavioral problems of the community, lack of persuasive communication and practicing ineffective messages are grouped as individual factors that affect the practice of health communication directly or indirectly whereas absence of health communication strategy guidelines, lack of mainstreaming health communication as important ingredient with urban sanitation, shortage of health extension workers, lack of health extension professionals were categorized under institutional factors. Thus, to alleviate such gap a defined health communication strategy could be designed and implemented in urban sanitation properly Key words: communication, health communication, health extension program, urban sanitation