Purpose: This study aimed to explore the relationship between community engagement practices, maternal and neonatal health services utilization, and health outcomes in rural communities in Tanzania. Methods: Using a Mixed-Method Case study design, we purposefully selected two communities; an exemplary community regarding better neonatal outcomes and community engagement practices (Community A) and the other with the highest percentage of perinatal mortalities (Community B) in the Mbalari District. Case community selection was based on the 2019 District Health Information Software (DHIS2) perinatal mortality records. We interviewed maternal and child healthcare stakeholders on their community engagement practices; we used the community survey checklist to collect more data on community engagement practices. We extracted maternal and neonatal health services utilization and health outcome data from each case community health center's 2019 maternal and neonatal health services registry. Cross-case analysis and community engagement level scoring tools were used to analyze community engagement practices. The ratio and proportions of neonatal and maternal health service utilization and outcome indicators were calculated using the Rmackdown software. We descriptively compared community engagement practices and the status of maternal and child health services utilization and health outcomes in the two communities. Results: Communities A and B are within a similar healthcare services provision context. Community B has a more developed infrastructure and is closer to emergency obstetric care services than Community A. However, more Community A pregnant women attended antenatal care (ANC) visits as recommended (77.1% Vs. 46.6%), started their first ANC visit during the first trimester (93.5 Vs.52%), delivered in hospital (100%Vs 93.2%) and delivered babies with higher average birth weight (3.27 kg Vs.3.12kg) than Community B pregnant women. Community A had more community-designed initiatives for promoting maternal and neonatal health services uptake than Community B. It also had a broader and higher level of community engagement- Cumulative Participation Value (CPV) scale ( 23/25 Vs. 9/25). Both communities had a very low utilization of postnatal and neonatal screening services ( 0.7% for Community A Vs.7.4% for Community B). Conclusion: Community engagement practices can impact maternal and child health services uptake and health outcomes.