Telemedicine services have been proposed as a solution to improve healthcare access in remote areas of Tanzania, particularly for mountain villages with limited infrastructure and resources. A mixed-methods approach was employed, including a quantitative survey of 300 patients who used telemedicine services between and , complemented by qualitative interviews with healthcare providers. Data were analysed to determine the prevalence and nature of accessibility issues. The analysis revealed that 45% of respondents experienced technical difficulties during their first appointment, significantly impacting their willingness to continue using telemedicine services. Despite initial challenges, patients reported higher satisfaction with telemedicine compared to traditional in-person consultations. However, persistent barriers such as poor internet connectivity and lack of digital literacy hinder long-term patient retention. To enhance patient engagement and service longevity, healthcare providers should prioritise infrastructure improvements, provide ongoing training on telemedicine use for both patients and providers, and implement flexible scheduling options to accommodate varying needs. Telemedicine, Patient Retention, Accessibility Barriers, Remote Villages, Tanzania