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IntroductionTimely access to emergency care services (ECS) is vital for reducing morbidity and mortality from acute conditions. While global barriers to ECS are well documented, little attention has been paid to access within primary healthcare (PHC) in low- and middle-income countries. This study assessed access to ECS at PHC in Tanzania, offering insights relevant to similar contexts.MethodsWe conducted a community-based, mixed-methods study in December 2021 across four villages in three Tanzanian regions. A structured questionnaire based on WHO-ECS indicators was administered to 673 randomly selected community members, covering healthcare access, awareness and barriers. Additionally, 12 in-depth interviews were conducted with village leaders and healthcare providers, and 4 focus group discussions with village health committee members explored systemic issues. Quantitative data were summarised using descriptive statistics, while qualitative data were analysed thematically. The primary outcome was the proportion accessing ECS, assessed across availability, acceptability, physical accessibility and affordability. Secondary outcomes included general healthcare access and perceived challenges, analysed using both quantitative and qualitative methods.ResultsAmong 673 participants, median age was 43 years (IQR 31–55); 55% were female, 68% had primary education and 89% were self-employed, mostly subsistence farmers. While 91% sought healthcare, only 27% sought ECS; of those, 73% obtained it. Most found ECS available (79%), affordable (64%), acceptable (59%) and accessible (57%). Barriers included long travel distances (48%), long waiting times (74%), medication shortages (64%), poor customer service (56%) and inability to pay (56%). Qualitative data revealed systemic issues such as poor infrastructure, low trust in facilities and preference for traditional healers.ConclusionOur findings underscore significant barriers to access to ECS at the PHC level. These barriers are systemic, infrastructural and sociocultural. Addressing them requires coordinated, multisectoral interventions involving policy makers, healthcare providers, decision-makers at national and local levels, and communities.