Full-text article. Also available at https://doi.org/10.1186/s12913-020-4961-9Background: Health system performance is one of the important components of health care delivery; its achievement depends on the quality of services rendered and the health system responsiveness of its beneficiaries. Health system responsiveness is a multi-dimensional concept and is usually measured through several domains. Health system responsiveness (HSR) remains to be a key indicator for the evaluation of health system performance in any settings. This study aimed at assessing the situation of health system responsiveness in primary health facilities in Tanzania prior to the introduction of the Direct Health Facility Financing (DHFF) program. Methods: This was a cross-sectional study conducted between January and February 2018. We collected data from 42 primary health facilities (14 health centres and 28 dispensaries) where a questionnaire was administered to a total of 422 participants. The questionnaire collected information on attention, respect to dignity, clear communication, autonomy, access to care, respect to confidentiality and basic amenities. Descriptive analysis was done to determine the distribution of the variables whereas ANOVA and linear regression analysis was employed to discern the association between variables. Results: More than 67% of participants had visited the same health facility more than 5 times. Sixty-seven percent of the patients were residing within 5kms from the public primary health care facilities. The geographical access to health care scored the lowest (43.5% for Dispensaries and 36% for Health centre) mean as compared to other domains of health system responsiveness. The highest score was with respect to confidentiality (86.7%) followed by respect to dignity (81.4%). Linear regression analysis revealed no statistical association between any of the social demographic features with the overall HSR performances. However, in post hoc analysis, Pwani and Shinyanga regions didn’t differ significantly in terms of their performances whereas those two regions differ from all other regions. Conclusion: Based on the study findings health system responsiveness domains has performed relatively poor in many regions except for respect of dignity and confidentiality scored high of all the domains. Shinyanga and Pwani regions scored relatively well in all domains this could have been due to the effect of Results Based Financing (RBF) in the respective regions. All in all the Government and other stakeholders in the health sector they should deliberately invest in the access to care domain as seem to be a challenge as compared to others.