Pay-for-performance (P4P) is a term that describes health-care payment systems that offer financial rewards to providers who achieve, improve, or exceed their performance on specified quality, cost, and other benchmarks. P4P programs are intended to increase the provision of quality care and decrease health care costs over the long term. This study assessed the provision of quality immunization services in Temeke Municipality following the introduction of Payment for Performance (P4P) strategy. The study provides useful information which could be used to advice the Municipality and the Ministry of Health and Social Welfare on refining P4P motivation scheme and even possibilities of scaling up to all Districts in all health facilities. We recommends that, the P4P implementation in Temeke should be revised and implemented systematically by ensuring stakeholders are consulted closely throughout the process, services included in the p4p scheme well defined and there should be a well designed monitoring and evaluation system. The other important steps include managerial capacity and capability arrangements, increasing p4p contractual transparency and ensure good governance.