Introduction: Ministry of health has started the implementation of health center reform guideline—a minimum standard which all health centers are required to function. Ethiopia health center reform implementation guideline (EHCRIG) implementation is regarded as one of the criteria for high performing primary health care unit. According to 2017 report on reform implementation status of public health center, their performance was found to be an avarage of 61% which is below the expected performance

Objective: The aim of this study was to assess the implementation status of Ethiopian health center Reform, staff awareness and its associated factors in public health centers in Addis Ababa.

Methods: Institutional based cross-sectional study was conducted in Addis Ababa in 4 selected sub cites of 31 public health centers from May 2018 to July 2018.  Health center reform guideline implementation data was collected using standardized checklist. A total of 664 participants were randomly selected from these 31 health centers to assess their awareness and its associated factors. Thirteen Key informant interviews were conducted to identify major gaps of the reform implementation. Bivariate and multivariate logistic regression analyses were executed to determine the presence and strength of association. The qualitative data was analysed by thematic approach using open code software

Result: The average EHCRIG implementation status of the facilities was 73.68%; it ranges from 48% to 97%.  The mean awareness score of EHCRIG of staffs was 57%. Profession of staffs [AOR=4.497; 95%CI (2.300-8.793)]; position [AOR=1.775; 95%CI (1.206-2.612)], total work experience of staffs [AOR =0.505; 95%CI (0.266-0.959)] and work experience in existing position [AOR= 0.460; 95%CI(0.325-0.650)] have significant association with awareness of EHCRIG. The following are identified as gaps in the reform guideline: standards are not contextualized; some of the standards are not applicable and achievable; it focuses on curative part of the service; some standards lack clarity and prone to subjectivity.

Conclusion and recommendation: Ethiopian health center reform implementation guideline score improves from the 2017 Addis Ababa city Administration health bureau assessment report but short of the minimum score expected from high performing primary health care unit—it should have been 80 %. Level of staff awareness about EHCRIG is low. Therefore it needs a concerted effort to improve staff awareness using different modalities. In addition, the guideline needs to rectify its gaps to make its implementation successful.

Key words: Health center, health center reform, implementation guideline, EHCRIG