RESEARCH ARTICLE Open Access Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region Said Nuhu 1,2* , Chakupewa Joseph Mpambije 3,4 and Kinamhala Ngussa 5 Abstract Background: Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania. Contrary, the expected outcomes have not been fully realised. This study aimed at investigating challenges encountered in implementing public-private partnership institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania. Methods: A qualitative case study design was employed, where in-depth interviews with stakeholders were held and document reviews conducted. Fourteen (n = 14) participants engaged in this study. Eight (n=8) and six (n=6) of the fourteen participants were from the public and private sector respectively. The thematic approach was used to analyse data, and ethical principles in the research process were upheld. Results: Findings revealed that although public-private partnerships are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. Several challenges encumber smooth provision of health services and these include inadequate resources, ineffective monitoring and evaluation, and insufficient consultations between partners. Conclusion: Inadequate legal and policy framework, or ineffective implementation practices may influence challenges facing institutional arrangements for public-private partnerships. Therefore, strengthening of public- private partnerships is recommended to improve implementation mechanisms and practices such as adherence to partnership agreements and compliance to the policies, laws and regulations. Keywords: Public-private partnership, Institutional arrangement, Health service delivery, Stakeholders, Tanzania © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. * Correspondence: said.nuhu@slu.se; sanutelaky@yahoo.com 1 Institute of Human Settlements Studies, Ardhi University, Dar es Salaam, Tanzania 2 Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Uppsala, Sweden Full list of author information is available at the end of the article Nuhu et al. BMC Health Services Research (2020) 20:765 https://doi.org/10.1186/s12913-020-05638-z