Non-communicable diseases (NCDs) remain a major public health and clinical concern worldwide. In many parts of Africa, traditional medicine remains a vital source of primary healthcare. This study examines the role of traditional medicine in managing of NCDs within the Iringa Care Utilization Model and the concept of medical pluralism. The study assessed how individual perceptions, structural access conditions, and health needs interact to influence treatment choices. To evaluate the knowledge and practices of traditional healers, the types of remedies used, and patient perceptions regarding traditional medicine for NCD management. This study employed a cross-sectional design to examine health-seeking pathways for NCD management in Iringa Region, Tanzania. A mixed-methods, cross-sectional design was employed with 120 respondents, comprising 18 traditional healers and 102 patients. Quantitative data were gathered using structured questionnaires and analyzed using descriptive statistics, while qualitative insights were obtained through in-depth interviews and analyzed thematically. The majority correctly defined NCDs as non-transmissible conditions. The main risk factors identified were low awareness and sugar consumption. Traditional healers administered remedies via oral, topical, and inhalation routes, primarily using plants such as Moringa oleifera, Psidium guajava, and Annona muricata. While half of the respondents found traditional medicine effective and affordable, others expressed concerns about side effects and inconsistent dosages. Traditional medicine was commonly used alongside biomedical care rather than as a substitute, reflecting adaptive and pragmatic responses within a plural health system. This study demonstrates that traditional medicine forms an integral part of health-seeking pathways for NCD management in Iringa Region. These practices should be understood within a plural health system rather than framed as alternatives to biomedical care. Public health policies addressing NCDs should acknowledge medical pluralism and develop context-sensitive strategies that improve coordination, safety, and patient-centered care.