In 2003, Ethiopia launched the Health Extension Program to address the shortage of first-line, primary care service providers at the community level. The program’s objectives were to reach the poor and deliver preventive and basic curative high-impact interventions to all Ethiopian people. At the heart of this program was the training and deployment of more than 30,000 health extension workers (HEWs) who are posted to rural communities across Ethiopia, where they provide better and more equitable access to health services for the poor, women, and children in a sustainable manner. The study described in this report was carried out to examine how and to what extent HEWs use data for decision making in Ethiopia, and the role of HEWs in implementing a referral system for family planning, reproductive health, and other services.