Tanzania is already facing challenges caused by existing burden of communicable diseases, and the growing trend of non-communicable diseases (NCDs), which raises a lot of concerns and challenges. The objective of this review is to provide broad insight of the “silent epidemic” of NCDs, existing policies, strategies and interventions, and recommendations on prioritized actions. A review of existing literature including published articles, technical reports, and proceedings from national and international NCDs meetings was carried out. The burden, existing interventions, socio-economic impact, lessons learnt, and potential for expanding cost effective interventions in Tanzania were explored. Challenges to catch up with global momentum on NCD agenda were identified and discussed. The review has indicated that the burden of NCDs and its underlying risk factors in Tanzania is alarming, and affects people of all socio-economic status. The costs of health care for managing NCDs are high, and thus impoverishing the already poor people. The country leadership has a high political commitment; there are policies and strategies, which need to be implemented to address the growing NCD burden. In conclusion, NCDs in Tanzania are a silent rising health burden and has enormous impact on an individual and country’s social-economical status. From the experience of other countries, interventions for NCDs are affordable, feasible and some are income generating. Multi-sectoral approach, involving national and international partners has a unique role in intensifying action on NCDs. Tanzania should strategize on implementation research on how to adapt the interventions and apply multi-sectoral approach to control and prevent NCDs in the country.