Background: Pay for Performance (P4P) programs are strategic health policy interventions intended to improve health worker performance and service delivery. Introduced in Tanzania in January 2011, the P4P program aimed to enhance reproductive and child health services. This study evaluates the effectiveness of the P4P program in improving maternal and child health services in Mkuranga District, assessing its impact on the quality and accessibility of these services. Methodology: A cross-sectional explorative evaluation combining qualitative and quantitative approaches was conducted. The study involved 31 health facilities and 123 healthcare workers providing maternal and child health services. Data on performance and motivation across four indicators were collected retrospectively before and after the Pay for Performance (P4P) program. Changes in motivation levels and client service proportions were analyzed for significance. To measure attitudes, a Likert scale was employed. Qualitative data were gathered through in-depth interviews with health workers. Results: The number of Antenatal Care (ANC) clients receiving IPT2 increased significantly in health centers and dispensaries (p<0.001). Measles vaccination rates showed no significant increase in hospitals (p=0.36), but significant improvements were observed in health centers (p<0.001) and dispensaries. Facility deliveries increased significantly in health centers and dispensaries (p<0.001), with hospitals exceeding target populations. A slight, non-significant drop in PENTA 3 vaccinations was observed (p<0.001). Conclusions: The P4P program positively impacts health worker motivation and performance. It is recommended to expand the P4P policy to other regions in Tanzania. Further case-control studies should be conducted to validate these findings.