Introduction Client-centred practice was theorised by occupational therapists in Canada and subsequently introduced into the Tanzanian occupational therapy curriculum. There has been no critique of its relevance for African countries, nor research into occupational therapists’ perspectives of applying client-centred practice in African world contexts. This study aimed to determine the understanding and use of client-centred practice by occupational therapists in Tanzania. Method A descriptive cross-sectional design was used. Working Tanzanian occupational therapists (n=64) completed a questionnaire based on two existing instruments. Data were analysed using SSPS (version 20.0) and qualitative coding. Results Barriers were shortage of time (79.7%), client-centred practice is too demanding for the client (78.1%) and the therapist and client have different goals (76.6%). Enablers included education about client-centred practice as a student (98.4%), client involvement in planning services (96.9%) and staff and service provider training (96.9%). Three themes were identified: client-centred practice enriches relationships, is difficult to implement, and needs to be supported by increasing human resources, further training and client education. Conclusion The implementation of client-centred practice in Tanzania is compromised by the resource-constrained and hospi-centric health service context. Alternative practice approaches that are aligned with collectivist cultural attitudes could be considered.