High focus is put on the provision of health services and service providers in Kenya, since the Health Sector is seen as one of the vital service providers and is one of the pillars of vision 2030. Priorities in public healthcare systems must be set for a variety of areas, including but not limited to human resource management (hiring, orienting, and developing staff, keeping them in their positions, ensuring their well-being, encouraging their active participation, and rewarding their dedication). The purpose of this study was to determine the effects of performance based compensation on employee performance of Chuka level five hospital in Tharaka Nithi County. Guided by Ability motivation opportunity theory. The study used descriptive research design, targeting a population of 484 health workers in Chuka level five Hospital in Tharaka Nithi County, from which a sample size of 219 was determined using Yamanes formula. A stratified random sampling was used in selecting the health workers, the study further used simple random sampling within the different strata to select 205 health workers and 14 health management team members from the hospital. Purposive sampling was adopted for small populations like the hospital administrators in this study. A pilot study was used to pretest data collection instrument before data collection for validity and reliability. Questionnaires and scheduled interviews were used in gathering information. The results of bivariate regression indicated that compensation practices have a statistically significant impact on the employee performance. Thus, based on the evidence from this study, compensation practices used by the hospital have statistically significant effect on employee performance.