Traumatic brain injury (TBI) currently has a global incidence rate of 200 per 100 000 people per year. A growing public health issue, the burden of TBI is distributed disproportionately with the highest incidence rates of 170 per 100 000 people per year in Sub Saharan Africa. The young productive population between the ages of 15 and 45, particularly males have been shown to be at a significantly higher risk for TBI. When strategizing resource allocation in limited resource settings it is important to understand the current capacity of the system and where the barriers to access to care lie to improve outcomes and lower the socioeconomic burden of TBI. This is a prospective cohort study to understand the state of pre-hospital care available and barriers to care for patients presenting at a major referral hospital with neurosurgical capacity over 4 months, in Moshi Tanzania. Preliminary results show that of 337 patients enrolled none received pre-hospital care including first aid, 63% of patients use more than one mode of transport to reach the hospital with the private car being the mode on the first leg and ambulance being the mode on the second leg. The mean time to reach the hospital is 55 min after departure from point of injury. The average patient arrives at the hospital just within the golden hour where treatment has been shown to have a significant effect on outcome yet mortality is high. Contributing factors are analysed using multivariable regression for association to worse outcome measured by Glasgow Outcome Score. Consideration is taken to control for variables such as age and presenting Glasgow Coma Score. Following the descriptive analysis of barriers to care ore TBI patients in this setting recommendations are made for policy and clinical practice guidelines to improve outcomes.