The statement from the Roll Back Malaria Summit held in Abuja, Nigeria in 2000, suggested that the strategy for Malaria prevention among pregnant women and under five children is to increase equity in ownership and use of Insecticide Treated Nets (ITNs). In what appears to be the response to the Abuja Summit agreement, the government of Tanzania in 2004, introduced a subsidized voucher scheme that distributed ITNs to pregnant women and under five children through Reproductive and Child Health (RCH) clinics in all districts countrywide. Following some allegations that at some places in the country vouchers were misused and did not reach the intended individuals, the scheme was terminated in July 2014 in order to review the process. It was critical at this level to understand the extent to which the program has been able to change the coverage and utilization levels of ITNs among target groups (pregnant women and under five children) in Bukoba District Council. Methods: A cross sectional survey was conducted to assess the level of coverage and utilization of ITNs among under five children and pregnant women in Bukoba District Council. Data were collected using questionnaire, a check list, and a semi-structured interview guide. Questionnaires were administered to 113 randomly selected respondents. Interview guide was used to one Focused Group Discussion, and to 3 key informants purposively selected to participate in the study, whereas a checklist was administered to 8 participants (RCH staff) to examine the effectiveness of the implementation process. The criteria for selection of study units were as follows: A beneficiary respondent was supposed to be having an under five child who is attending RCH clinic, a key informant was supposed to be a person who was involved in the implementation of the scheme at District level and believed to have good knowledge about the scheme. For a service provider to participate, he/she was supposed to be working at RCH clinic. A mixed method was employed, quantitative data were analyzed using STATA Version 13.0, while qualitative data were organized using ATLAS.ti software.