Introduction: Patients’ satisfaction is a measure of health system performance and can be used as a foundation of encouraging health care providers to become more responsible to their patients. Satisfaction manifests its’ self as a distribution, access and utilization of health services. Objectives: To determine factors influencing patients’ level of satisfaction with the health care services received in outpatient department in Kilimanjaro Region. Methods: This study was conducted at Mawenzi, Same and Rombo hospitals. A comparative cross-sectional study was used, using Donabedian model to determine factors influencing patients’ level of satisfaction with the health care services received at outpatient departments in kilimanjaro region. Systematic sampling was used to select 450 patients attending OPD during the study period. SERVQUAL questionnaire was used to collect data from 450 patients. Data entry and analysis was performed using SPSS version 20. Results The overall patient’s level of satisfaction with health service provision at OPD in all three hospitals was only 20%.The gap on health service provision in all three hospitals was -37.0 (±47.0) signifying overall dissatisfaction among patients in health service provision. No significance difference found in satisfaction gap with quality of service provision in the three hospitals, though a significant gap difference in the satisfaction with service provision was demonstrated between Huruma DDH and Same District Hospital (p, 0.002) with a smaller gap in satisfaction with service provision at Huruma DDH compared to Same (-28.0 vs. -46.7). The level of dissatisfaction in the five service dimensions tested was on Empathy (-7.8). Conclusion Patients attending OPD in all three hospitals demonstrate an overall dissatisfaction on quality of care. Hospital management should focus on: improvement on patient-provider relationship, availability of equipments and drugs and affordability of hospital bills. Keywords: Patients, satisfactions, service, hospital Tanzania.