ABSTRACT Literature and other background information on prevention of mother-to-child transmission of HIV (PMTCT) and maternal syphilis screening programmes in Tanzania reveal that little has been documented on accessibility and utilization of these services. This thesis presents the results from a research conducted in Mwanza city, Tanzania to assess the operational performance of PMTCT and maternal syphilis screening and treatment during pregnancy, at delivery and in the postnatal period. From different sub-studies conducted at the antenatal clinics (ANC) and in the maternity ward for this research, a number of missed implementation opportunities were identified. A review of records found that 24% of pregnant women who delivered in hospital left the maternity ward with unknown HIV status and 50% of HIV-positive women tested at ANC did not receive Antiretroviral therapy (ART) for PMTCT. A cross-sectional study at the maternity ward found that 12% of pregnant women who were not screened for syphilis, 27% of RPR-positive women who were not treated at ANC, and all infants of RPR-positive women did not receive any intervention to prevent congenital syphilis. Forty-one percent of HIV-positive women recruited in the cohort study successfully completed all PMTCT interventions. Only 18% of HIV-positive women identified through PMTCT were successfully referred to, and attended an adult care and treatment clinic (CTC). Of 403 HIV- positive women in the cohort study, 50% did not intend to get pregnant and by four months postpartum, 20% of them reported to have not received any counselling on family planning. HIV-positive women who did not receive counselling on FP use were at a higher risk of not using contraception compared to those who were counselled (adj. OR=6, 95% Cl; 2.8-12.9). About 27% of HIV-positive mothers were not counselled regarding infant feeding and 40.2% of women who were not counselled on infant feeding were undecided on how to feed their infants before they left the hospital compared to only 2.5% of women who were counselled (P<O.OOl) It was found that pregnant women attending ANC for the first time during pregnancy spent between three and 5.5 hours at the clinic, on average, 78% of this time was spent waiting for services. 6 Fewer ANC visits, attending private or rural ANC facilities, failure to attend a CTC prenatally, and lack of knowledge among users and provider of health services were factors found to hamper the performance of the programmes. Integration of these programmes at all levels and training of health workers in basic components of the programmes are fundamental to the successful implementation of the programmes