A dissertation Submitted to the School of Public Administration and Management (SoPAM) in Partial Fulfillment of the Requirements for award of the Degree of Master of Public Administration (MPA) of Mzumbe University 2013This study identified the opportunities and constraints in medical provisioning as a result of health service agreements (PPP) in health sector. The study was conducted at KCMC in Moshi Municipality. The objectives of the study were to examine if health service agreements have resulted in the achievement of national health goals through its policies and guidelines in medical provisioning, to identify constraints that lead to unavailability of drugs and to identify opportunities in medical provisioning that are the results of health service agreements. The sample size of the study involved 84 respondents. The key respondents of this study were MSD zonal manager, director of health services at KCMC, head procurement department, head pharmacy department, ten pharmacists, ten MSD employees, twenty nurses and forty patients. The selection of the respondents was based on both purposive and accidental sampling techniques. In this research, a case study design was used. With regard to the introduction of PPP, the study findings revealed that the introduction of PPP has improved the health service delivery. Before PPP in 1990, accessibility to drugs was 45% while after PPP the drugs provision improved by 30% to make total accessibility of 75% in 2000s. Not only access to drugs availability, but PPP improved efficacy and effectiveness on service provision, Outpatients attendance also increased, This is because of better services. The findings also revealed that there are some factors that lead to constraints in PPP, particularly in medical provisioning, for example bureaucracy, budgetary constraints, human resource capacity, mistrust and poor policy implementation. Conclusively, PPP should be cemented by clear plans and strategies by every actor in the partnership, with a focus to good and harmonized policies. The government should avoid bureaucracy and practice full decentralization of PPP in medical provisioning.