Despite recent progress in increasing the world’s population with sustainable access to safe drinking water, hundreds of millions still rely on unimproved sources. To improve the quality of drinking water, various household water treatment and safe storage methods have been developed, adopted and promoted as alternative interventions. However, there is paucity of information regarding drinking water quality and prevalence of HWTS practices especially from the users’ perspectives in Tanzania. This paper examines users’ perceptions on drinking water quality and household water treatment and storage practices in the selected towns of Misungwi, Magu and Lamadi in Northwestern Tanzania. The specific objectives of the study were 1) to examine users’ perceptions on drinking water quality, and 2) to identify household water treatment and storage methods used in the study towns. The paper is based on empirical primary and secondary data collected from 417 households, through survey, key informant interviews, observation and documentary review, and analysed for descriptive statistics, chi-square tests and qualitative content analysis. The study found that water supply coverage in the study towns was generally low. Households drew water from various sources, including ones which were not suitable for drinking. This necessitated households to improve the quality of their drinking water through HWTS practices. Although a combination of adequate and inadequate treatment methods was used to improve water quality and aesthetics, prevalence of HWT practices was generally low. Similarly, safe storage was rarely practiced. Therefore, interventions aimed at improving access to domestic water supply should also incorporate elements of water treatment and safe storage at the point of use to contribute to improved health outcomes.