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This study examines the role of training and development in enhancing work engagement and service quality in rural public health facilities in Tanzania. Grounded in Social Exchange Theory, Job Demands-Resources Theory, and the SERVQUAL model, the study adopts a positivist paradigm, a deductive approach, and a cross-sectional survey design. Data were collected from 285 respondents across 63 health centers and dispensaries using self-administered questionnaires. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed for data analysis. The findings reveal that training and development significantly enhance work engagement, which in turn positively influences service quality. Furthermore, work engagement partially mediates the relationship between training and development and service quality, highlighting its pivotal role in translating employee development initiatives into improved service outcomes. These results underscore the importance of investing in training and development programs to foster employee work engagement and enhance service quality in rural health facilities. The study provides valuable insights for policymakers and healthcare administrators aiming to improve healthcare delivery in resource-constrained settings.