This study was carried out to assess the strengths and weaknesses of the eye health system in mainland Tanzania, to facilitate the design of new eye health initiatives aimed at improving, and the scaling-up of, eye care services in the country. This study had four specific objectives: (1) Describe the nature and functioning of the broader country health system in Tanzania. (2) Describe the nature, scope and functioning of the eye health system and how it is integrated in the broader health system. (3) Document and disseminate ‘lessons learned’ and best practices for consideration during relevant policy review/formulation processes. (4) Determine the relative strengths and weaknesses of the eye health system and make recommendations for strengthening the country’s eye health system and innovations.