The Ministry of Health of the Republic of Chad decided to introduce a performance-based financing (PBF) strategy as a pilot project in eight districts of rural areas, from October 2011 to May 2013. Based on both qualitative and quantitative data collected during the implementation of the scheme, this study aims to reflect on the early results of the scheme and draw valuable lessons to inform future scaling up of the strategy. Despite some methodological limitations, the results show that overall access to health services and quality of care improved in the period considered, even though some indicators reacted less. These positive results resonate with the findings of our qualitative interviews that highlighted changes in ways of providing care as well as managing health facilities and regulating the health system. However, results vary substantially between regions (north and south) and between facilities. Moreover, the short duration of the project leaves the sustainability of these changes in question. In conclusion, our study stresses the need for evaluations and an evidence-based discussions in order to tailor the design of PBF scheme to the context, and to better inform policy-making decisions on PBF schemes, both at pilot stage and when considering their rollout nationwide.