A study conducted by the Ministry of Health and Social Welfare (MoHSW) (2011) on assessment of the situation of children in institutional care in Tanzania indicated that there are more than 500 residential care centres. It is estimated that there are 40 residential care centres providing support to almost 2000 orphans and vulnerable children (OVC) in Dar es Salaam (MoHSW 2011). Unfortunately, in Tanzania apparently no recent nationwide comprehensive situational analysis has been conducted of OVC in various alternative care systems, other than a baseline survey on a situational analysis of OVC in residential care centres conducted by the Department of Social Welfare and non- government organisations. This limits the understanding of the number of OVC under the support of other alternative care systems, the nature of services provided, and challenges experienced. The objective of this paper is therefore, to examine the situation of OVC in existing alternative care systems and explore the treatment of OVC in these systems. Lastly, the paper will recommend what can done to curtail the OVC problem.