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 itself as a distribution, access and utilization of health services. This study aimed to determine patients' level of satisfaction with the health care services received in outpatient department in Kilimanjaro Region. Methods:A cross-sectional study design was conducted at Mawenzi Regional Referral Hospital (MRRH), Same District Hospital (DH) and Huruma Designated District Hospital (DDH) using Donabedian model to determine patients' level of satisfaction with the health care services received at outpatient departments in Kilimanjaro Region. Systematic sampling was used to select 450 patients. Service quality questionnaire was used for data collection. Descriptive statistics was performed. Paired sample t-test, independent sample t-test and one-way ANOVA with Bonferroni posthoc test were used to compare mean gap scores. A p-value of <0.05 was considered statistically significant. Results:The overall patient's level of satisfaction with health service provision at OPD in all three hospitals was 20%. The gap on health services provision in all three hospitals was -37.0 (± 47.0) signifying overall dissatisfaction among patients. No statistically significant difference (p<0.05) on the gap in satisfaction with quality of service provision existed between MRRH and Huruma DDH as well as between MRRH and Same DH. However, a significant gap difference was demonstrated between Huruma DDH and Same DH (p, 0.002) with a smaller gap in satisfaction at Huruma DDH compared to Same DH (-28.0 versus -46.7). The highest 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 with quality of care. Hospital managements should focus on: improvement of patient-provider relationship, availability of equipment and drugs and affordability of hospital bills.