Introduction: Delays on TB treatment initiation prolong disease transmission, worsen illness, and increase cost of care those result in poor outcome among patients. Objective: To determine magnitude Delay on tuberculosis treatment initiation and its associated factors among its Patients at Gurage Zone Public Health Facilities, Southern Ethiopia, 2021.Method: Institution-based cross-sectional study design was conducted among systematically selected 316 tuberculosis cases on treatment from 19 randomly selected public health facilities found in Gurage zone. The data was collected using interviewer-administered questionnaire and Observational checklist from May 1 to June 30, 2021 and entered into Epi-data version 3.1then exported to SPSS version 21. Logistic regression analysis was performed to identify associated factors with delay and a p-value of less than 0.05 at 95% of confidence interval was considered to declare significant association. Result: Magnitude of delay on tuberculosis treatment initiation was 190(61. 1%).Rural residence [AOR=5,95% CI; (2.1, 13)], self treatment [AOR=2.4,95% CI; (1, 6)] visiting traditional healers before health care facilities [AOR=4.9,95% CI; (1.1, 20.7)], Fear of exposure to COVID 19[AOR=2,95% CI; (3, 4.4)] and having poor knowledge about Tuberculosis [AOR=2.6,95% CI; (1, 6)] were significantly associated patient related factors. similarly, history of referral because of lack of x ray [AOR=4,95% CI; (1.4, 11.9)]and self-referred because of providers unable to diagnosis the illness [AOR=4,95% CI; (2, 8)], multiple health provider contact [AOR=4.6,95% CI; (1.9, 10.9)]and travelling for more than an hour to reach into first visited health facility [AOR=9,95% CI; (4, 21)] were health system related factors that independently predict higher odds of delay treatment on tuberculosis treatment initiation exceeding Four weeks. 7 Conclusion and recommendation: Tuberculosis cases in this study elapsed too long time to initiate treatment. The delay was attributed to the patient and health system related factors. Engagement of informal providers such as traditional healers, strengthening health care capacity in early case detection and treatment initiation and community level awareness creation about tuberculosis and COVID 19 and their control strategies may reduce the delay.