Ethiopia has been implementing focused antenatal care package to reduce maternal and child deaths. The quality of antenatal care service has being not resolved widely due to unstandardized measurement. Hence, this study assessed determinants of focused antenatal care service satisfaction in Public Health Facilities of West Guji Zone, Ethiopia, 2018. a facility based cross-sectional triangulated with qualitative study design was conducted and used multistage sampling techniques to select 810 pregnant women in West Guji Zone in Feb 5-28/2018. Key informants were selected purposively for in-depth interview. Internal reliability test checked and Crobach‘s alpha became 86.5%. Data was cleaned, coded, entered to EPI INFO software, and then exported to SPSS version 21 for analysis. Predictors in multivariate logistic regression analysis determined where p value less 0.05. Qualitative data were thematically analyzed and triangulated for final conclusion. the overall prevalence of satisfaction was 66%. The predictors of overall satisfaction level were urban resident (AOR=1.91, 95%CI:1.07-3.35), being male’s sex service provider (AOR= 0.42, 95%CI :0.31-0.70), housewife in occupation(AOR=5.81,95%CI :1.06-31.35), living alone (AOR= 0.16, 95%CI:0.04-0.71), waiting time 30-60 minutes (AOR= 0.62, 95%CI :0.40-0.99), frequency ANC (AOR= 0.35, 95%CI :0.16-0.76), care giving approach (AOR= 5.10, 95%CI :2.10-12.51), and service provider respect (AOR= 2.41, 95%CI:1.31-4.50). three-in-ten study women were dissatisfied with service they received and predicators were rural residence, being male service provider, government employee in occupation, living alone, 30-60’ waiting time duration, frequency of antenatal care visit, care giving and respectful approach of service provider. Therefore, a multidimensional intervention is crucial to alleviate multifaceted negative outcomes in maternal health

Keywords: antenatal care, child, maternal satisfaction