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In Ethiopian by 2008 there were estimated 36,000 HIV positive pregnant women but only 18% were receiving ARVs. A process evaluation was conducted to the Prevention of Mother-to-Child Transmission (PMTCT) program in a selected health facility (Agaro Health Centre) on the South West of Ethiopia. A case study with both quantitative and qualitative methods was used. It was found that generally the PMTCT program implementation was complying with the Ethiopian national guidelines; there was sufficient number of trained human resource, counseling sessions, ARVs and safe delivery practices. About 60% of respondents showed to be satisfied by the time spent to see the provider and total time spent for services provision. Additionally 96% of respondents said that they received their HIV test results within one hour. However there were shortcomings such as; stock out of test kits and reagents, laboratory materials and opportunistic infection drugs. Also clients complained about the delays found in the card room. There was a need to ensure privacy of counseling rooms, availability of materials, supplies, training, and counselors should record provided services for monitoring and evaluation.