<p>Cardiomyopathies, particularly, dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) are significant and growing public health concerns in low resource settings, particularly Africa. This growing burden stems from undiagnosed genetic causes, rising hypertension and infectious diseases, and limited access to diagnostic and specialist cardiac care. However, the epidemiology of these conditions remains poorly defined. In Europe and North America, genetic testing has proven to be an important tool for early diagnosis for these conditions. Its use can be extended to risk assessment, personalized management, and increased understanding of disease mechanisms. However, the availability and implementation of genetic testing in Tanzania are limited, hindering its potential to improve patient outcomes. This Perspective evaluates the current epidemiology of cardiomyopathies in Tanzania, to provide a broader view on the underlying genetic factors, systemic barriers to implementing genetic testing and counseling, and proposes actionable solutions to overcome existing challenges. While similar needs have been recognized across Africa, this Perspective emphasizes how context-specific framing in Tanzania, grounded in real-world clinical and health system features, remains essential to catalyze local implementation and policy reform.</p>