This study sought to establish the monitoring and evaluation challenges and approaches by Non-Governmental organizations in Musoma, Tanzania using the cross-sectional quantitative study design. The approval to conduct this study was sought from the Ethical Committee Board of the Open University of Tanzania. The permission to collect data was further obtained from particular organizations and the respondents gave their consent before the data collection. A total of 44 respondents from 11 organizations were involved as respondents. Data was cleaned and analyzed by using the Statistical Package for Social Science (SPSS) Version 24 in frequencies and percentages. The result oriented approach was the most common used approaches. Other approaches such as Logical Framework, Reflexive and Constructivist approach were utilized depending on the need and nature of the project being implemented. An insufficient fund, inadequate skilled M&E experts and varying reporting requirements from multiple donors are challenges facing the majority of NGOs during implementation of monitoring and evaluation. The authors recommend the use of available experts in monitoring and evaluation to train the employees on the proper selection of the M&E approaches depending on the project needs. The authors also recommend the employees to utilize the available free online courses and trainings that do not require funds to improve their skills in monitoring and evaluation.