Background: - Globally, there are an estimated 34 million people living with HIV (PLHIV), the vast majority of who live in sub-Saharan Africa and every day over 5700 persons die from AIDS. Mother-to-Child Transmission is by far the largest source of Human immunodeficiency virus infection in children under the age of 15 years and the virus can be transmitted during pregnancy, labor, delivery, or after child’s birth during breast feeding. PMTCT service consumption at Antenatal care was not assessed in the hospitals. So the objective was to assess the quality of PMTCT service. Methods: - The study was conducted at Bedelle and Mettu Karl hospitals with a hospital based cross sectional study design. The study conducted from March – April 30/2015. About 195 pregnant women were participated in exit interview and 6 direct observations were done. Data on client satisfaction, counselors’ communicative skills, duration and content of pre- and post-test counseling was collected using a structured questionnaire adapted from UNAIDS tools. Result: - One hundred sixty-six 166 (85.1%) of the clients said that the counseling room’s door was closed, and 131(67.2%) of the clients were need to have different counselors. The mean duration of pretest counseling sessions was 20.8 minutes. Both the hospitals were observed offering individual pre- and post-test counseling by trained health personnel. Conclusion: - Overall, counselor’s communicative skill (introductory/interpersonal relationship, gathering information from the clients, and giving information to the clients) was generally “satisfactory”. The majority of pre-test sessions included the basic information on HIV transmission and prevention and PMTCT. However, this study revealed that the discussions were rudimentary and lacking in depth and coverage in many of the counseling sessions. The administrative health bureau should facilitate ongoing (refreshment) training for the counselors to equip them with recent information. As well additional health workers should be trained to share the burden of the work.