A dissertation Submitted in Partial/fulfillment of the requirement for the Degree of Master of Health Monitoring and Evaluation.Background: Registration of births and deaths is vital for the proper planning and development of the country but the global and local records show that there is more than 40 million births and deaths that goes unrecorded worldwide. Methodology: Formative evaluation using qualitative research methods was applied to try to establish why the registration is low in Tanzania, the country with centralized government structure and that enjoyed peace for most of the time. Eleven key informant interviews (n=11) and three focus group discussions (n=28) were conducted in three villages that were purposively sampled. Findings: People with birth certificates were very few regardless of being provided with notification and the reason for not having certificates ranged from low level of knowledge on importance, distance to the registration office and costs associated with registration. Death registration was found to be nonexistent at the community and few registered were those affiliated to legal/police issues and of deceased who left wealth. Overall accountability for the Village Executive Officers (VEO) to the Registration Insolvency Trusteeship Agency (RITA) office was totally missing as the evaluation villages had not registered any births or deaths for years and no one asked or made a follow up. Conclusion: The overall awareness on the importance of registration of births and deaths was low not only to the community but even to those assigned to conduct this work. The state agency (RITA) needs to conduct continuous sensitization especially at the communities and bring the services closer to people. The government and other stakeholders are missing important data for planning.