This research article published by the Journal of Health Informatics in Developing Countries, 2019Background: Blockchain technology is a distributed electronic ledger containing digital records, transactions or events that are protected with advanced encryptions, extremely hard to tamper, and updateable through a consensus algorithm agreeable to all connected network nodes. In Sub-Sahara Africa, the technology has started to be adopted in real estate, supply chain, agriculture, and financial sector. Unfortunately, there is a lack of effort in introducing this technology in the healthcare sector. Therefore, this study aims to explore the issues facing electronic healthcare systems in Sub-Sahara Africa taking Tanzania as a case study and introduce blockchain-based solutions for the discovered issues. Methods: The study used qualitative methods for data collection and analysis. Data were collected through interviews, observation and documentary analysis. Interviews were done with the sample size of 50 participants who were selected from groups of healthcare facility leaders, ICT experts, government representatives, doctors, nurses, laboratory technicians, pharmacists, accountants, and receptionists. Direct observation and participatory observation were used to assess different electronic healthcare records systems’ functions. Moreover, researchers used document analysis to collect data from public records (like policy manuals), personal documents (like incident reports), and physical evidence (like training materials and handbooks). NVivo 11 software was applied in managing and organizing data analysis. Results: Out of 710 healthcare facilities involved in this study, 34.5% fully implemented electronic healthcare records systems and 78% installed Mfumo wa Taarifa za Uendeshaji Huduma za Afya (MTUHA) also known as (District Health Information Software (DHIS) II). The findings showed that the issues facing electronic healthcare records are; difficulties in taking care of the patients’ private information, problems in safely sharing medical information between healthcare facilities, bandwidth issues, and improper handling of data integrity.