This study assessed how effective employee performance management is in Tanzania public health facilities. Primary data were collected from personnel responsible for human resource management in public health facilities through the use of questionnaires and interviews in Tanzania mainland. It was found that a considerable number of health workers in Tanzania do not understand well how to use the performance management system in place (Open Performance Review Appraisal System-OPRAS). Participatory goal setting was found to be challenging since employees are not given sufficient autonomy to identify and discuss what they are supposed to achieve. Goal implementation has been also affected by the fact that health facilities are allocated with limited resources. The study recommends designing and implementation of capacity building programs to help health workers mastering the use of OPRAS. Supervisors and managers of health facilities should insist participatory goal setting to stir-up motivation and commitment of health workers. The government should increase budget allocated in health facilities to increase employee performance.

Keywords: Performance management, Performance appraisal, Health sector, OPRAS, Health systems, Tanzania.