 This study examined the effects of performance-based financing, PBF, in Burkina Faso. It found that while PBF can be beneficial in some ways, it can also lead to undesirable unintended consequences. These include the manipulation of medical records, the pursuit of narrow and less relevant performance indicators, gaming, and teaching trainees improper practices. Additionally, the long payment delays were a source of dissatisfaction and demotivation among providers. Furthermore, the study found that PBF led to numerous unintended consequences that could undermine the intervention's effectiveness. This article was authored by Amri Terkot-Trumbley, Idris Ali Gali Gali, and Valerie Rida.