Background: Antenatal care is a care which a woman receives during the pregnancy to reduce the risks by monitoring the woman's health regularly and offering preventive services. The quality Antenatal care ensures the good health outcome for the pregnant woman and her newborn. Aim of the study: To assess the quality of antenatal care in Moshi Municipality, Tanzania. Methodology: This is a cross-sectional descriptive study. The checklist was used to assess the quality of antenatal care structures and the interview schedules were used to collect data from pregnant women to assess the quality of antenatal care processes. The quality of all 19 health facilities providing antenatal care were stratified into three levels which are 2 hospitals, 3 health centers and 14 dispensaries. All 19 health facilities providing Antenatal care services were selected purposively to be included in the study. In this study 384 participants were involved. The ratio of 3:4:2 was used to select participants conveniently to participate in the study from the health facilities which provide the antenatal care. The SPSS version 16 was used to analyze the data. Results: Out of 384 study participants, 114 (29.7%) of pregnant women were checked for hemoglobin and only 24.0% of these information was recorded in the clinic card. Over three quarter were provided with Folic acid and Mebendazole and 108 (28.1%) received Sulfadoxyne Pyrimethamine. Nearly all respondents’ blood pressure and weight were measured. Half of respondents were not checked for Oedema but the clinic card shows 98.7% were checked. Over 80% had received health education on birth preparedness. Nineteen percent had received the information about family planning, however, 365 (95.1%) of this information was recorded in the clinic card. Less than 10% were provided with the subsidized Insecticide Treated Nets voucher. All 19 health facilities visited had inadequate health staff and in almost half of the dispensaries had the shortage of Sulfadoxyne Pyrimethamine and 57.1% of dispensaries had no ferrous sulphate. Almost all the health facilities had basic diagnostic equipment though two out of three health centers and 3 out of 14 dispensaries had hemoglobin meter which were not working. All health facilities had HIV test kit but some had expired. Conclusion and recommendation: Compliance of health care providers to national Focal Antenatal Care guideline was poor. Human resource and materials were inadequate in most of the health facilities. The major cause of these shortcomings includes lack of supervision, negligence, and managerial weaknesses. The observed challenges undermine quality of care and national effort in improving maternal care. In service training and supportive supervision must be strengthened in order to address the identified problems at health facilities level.