The present study entitled “The use and management practices of medicinal plants by Shinasha people the most marginalized ethnic groups in Metekel Zone, Northwest Ethiopia” was an ethnobotanical study aiming to summarize and analyze the current knowledge of the Shinasha people on the medicinal properties of local plant species. This study is based on a survey involving a total of 99 informants (aged 20 and above). Data from the survey was analyzed following analytical tools for ethnobotanical methods as preference ranking, direct matrix ranking, paired comparison were performed and medicinal use value, fidelity level index and informant consensus factor were calculated. The study concludes that of 65 medicinal plants recorded, 48% are used for treatment of human maladies and 22% for livestock treatment. These medicinal plants include mainly Clutia abyssinica Jaub. and Spach, Cordia africana Lam., Croton macrostachyus Del., Solanu nigrum L., Datura stramonium L., Justicia schimperiana (Hochst. ex Nees) T. Anders., Ximenia Americana L., Sida schimperi Hochst. ex. A. Rich, Kalancheo petitiana A. Rich, Clematis hirsuta perr and Guill, Gardenia ternifolia Schumach & Thonn., Paveonia uren. Scav, Dichrostachys cinerea L., Grewia ferruginea Juss., Stereospermum kunthianum Cham., Portulaca quadrifida L. Etc. Majority of the plants used were herbs and the parts used was the leaf. Moreover most of the prepared remedies were administered to the patient orally in the form of drink. Justicia schimperiana and Nicotiana tobacum have high fidelity level index (FLI). Bersama abyssinica was the most preferred plant species for the treatment of snake bite and Withania somnifera for evil eye. Direct matrix ranking showed Cordia africana as the most utilized multipurpose plant species. The study area possesses diverse natural vegetation. However, its environment is under serious threat mainly due to agricultural expansion, free grazing, wildfire, timber logging etc. Hence, intensive awareness creating on the use and management systems, sustainable utilization of medicinal plants and their in-situ and ex-situ conservation should be recommended.