Abstract As the main purpose of Public Relations is information dissemination and promoting organizational reputation, dealing with stakeholders and proper information dissemination has a great role. The main objective of this study was to assess public relations activities in building organizational reputation at Werabe Comprehensive Specialized Hospital; by determining public relations activities, communications tools used by PR practitioners in the Hospital and stakeholder"s perception about the role of public relations practices. And a mixed research approach employed by the researcher to collect relevant data through questionnaire survey and in-depth interview. An in-depth interview was employed to collect detail information about PR practices of WCSH. Documents were reviewed to triangulate the data from questionnaire and informant interview. Results revealed that the practice of public relations is not based on its professional standards and the public relations practitioners were found to be using traditional and very poor communications tools that affect its effectiveness. Therefore, to overcome such challenges, proper communication strategies; such as, effective planning, training and implementation techniques are vital. Assigning the right professionals of journalism or communication for the Public relations practices is important to enhance the positive image of the hospital and to enable practitioners efficient. Stakeholders are also expected to work cooperatively in improving Public Relations practices to enhance the organizational image and reputation.