The Democratic Republic of Congo (DRC) is the second largest country in Africa by area, with the fourth largest population at 66 million (World Bank, 2012). It is also among the poorest countries in the world: the country is ranked second from the bottom of the Human Development Index (186 out of 187 in 2012) (UNDP, 2012), with an estimated per capita income of US$ 220 (current) in 2012 (World Bank, 2012). Impoverished by decades of war, instability and bad governance, it is not surprising that DRC is not on track to reach the health-related MDGs.Since the democratic elections in 2006, the country has started a slow reconstruction phase and a decentralization process, with the election of provincial governments, including provincial ministers of health. The government’s 2006 health sector strategy emphasizes development of the health zone system, indicating that contractual approaches and public-private partnerships will increasingly be options for health service financing and delivery. Developing and putting in place effective service delivery models such as Performance-based Financing (PBF) would be a strategy for improving health outcomes among the population.This study examines the effect of financial incentives to health care providers linked to performance on health service delivery outcomes in the district of Haut-Katanga, DRC.