For long time provisioning of health care facilities in Tanzania has been based on threshold population and hierarchy of administrative units. Even after liberalizing health care service delivery, the motive has been the same and the approach has been applied to both urban and rural settlements. However, this approach has been seriously overtaken by the rapid urban population growth in towns and cities in Tanzania. Sustainable urban form and central place theories are used as a framework of analysis of the research issue. This paper applies multiple case study analysis to understand key variations that exists among the administrative units in Dar es Salaam which prompt for new approach for providing urban health care facilities.Focusing on the case of Charambe and Chamazi Administrative Wards, which are among the 73 Administrative Wards which comprise Dar es Salaam city, the study analyses physical accessibility, densification of settlements and population dynamics, and how they influence location and distribution of health care facilities. The geographical information system (GIS) is used to analyze the spatial distribution of health care facilities and how they correlate with other urban functions such as physical accessibility and residential housing.The study has found that provisioning of health care facilities based on the hierarchy of administrative units is not successful due to the oversight of the variation which exists among administrative wards due to rapid urbanization. The specific limitations of provisioning of health care facilities based on the administrative units includes its failure to analyze the demographic characteristics of both urban and peri-urban wards; settlements’ densification due to informalities in land development and potentials of physical accessibility in attracting private health care providers.The paper concludes that location and distribution of health care facilities in rapid urbanizing context should respond to the population dynamic, nature of the city growth and physical accessibility. Due to difficulties in regulating spatial location of private health care facilities, there are very big spatial disparities of distribution of health care facilities in urban areas. It has been empirically confirmed that private health care providers concentrate in highly accessible areas in the inner city leaving peri-urban and less accessible areas with poor distribution of health care facilities. Therefore, public-private model of health care service delivery which emerged after privatization, should not only focus on the administrative units and threshold population as the key criteria to provide health care facilities but also take into account variations that exist within these units.