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Understanding the managerial competency of healthcare managers is very important. However, more evidence is needed on the managerial competency of primary healthcare facility managers in low- and middle-income countries. This research examined the managerial competency of primary healthcare facility managers in the selected District Councils in Tanzania. This research is grounded on positivism philosophy, a cross-sectional survey descriptive research design, a complete enumeration sampling strategy, and a survey used to collect primary data from 102 public primary healthcare facility managers located in Kondoa, Iramba, and Sumbawanga District Councils in Tanzania. The study used version 25 of SPSS to analyze the data and adopted the MCAP framework to examine the managerial competency of primary healthcare facility managers. For the communication and relationship management domain, 74.5% were competent, while 25.5% were less than fully competent. Likewise, 65.68% of them were competent, while 34.32% needed to be more competent in the knowledge of the healthcare environment domain. 62.74% and 37.26% of the primary healthcare facility managers were competent and less than competent in operations, administration, and resources management. Correspondingly, 67.65% and 32.35% of primary healthcare facility managers needed to be more competent in evidence-informed decision-making. Similarly, 74.55% and 25.45% were competent and less competent in enabling and managing change. The study used primary data and contributed recently well-worth and highly demanded knowledge on the managerial competency of healthcare managers in the LMICs.