The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .
Impact of performance-based financing on primary health care services in Haiti.
To strengthen Haiti 's primary health care ( PHC ) system , the country first piloted performance-based financing ( PBF ) in 1999 and subsequently exp and ed the approach to most internationally funded non-government organizations . PBF complements support ( training and technical assistance ) . This study evaluates ( a ) the separate impact of PBF and international support on PHC 's service delivery ; ( b ) the combined impact of PBF and technical assistance on PHC 's service delivery ; and ( c ) the costs of  PBF  implementation in Haiti . To minimize the risk of facilities neglecting potential non-incentivized services , the incentivized indicators were r and omly chosen at the end of each year . We obtained quantities of key services from four departments for 217 health centres ( 15 with PBF and 202 without ) from 2008 through 2010 , computed quarterly growth rates and analysed the results using a difference-in-differences approach by comparing the growth of incentivized and non-incentivized services between PBF and non-PBF facilities . To interpret the statistical analyses , we also interviewed staff in four facilities . Whereas international support added 39 % to base costs of PHC , incentive payments added only 6 % . Support alone increased the quantities of PHC services over 3 years by 35 % ( 2.7%/quarter ) . However , support plus incentives increased these amounts by 87 % over 3 years ( 5.7%/quarter ) compared with facilities with neither input . Incentives alone was associated with a net 39 % increase over this period , and more than doubled the growth of services ( P < 0.05 ) . Interview findings found no adverse impacts and , in fact , indicated beneficial impacts on quality . Incentives proved to be a relatively inexpensive , well accepted and very effective complement to support , suggesting that a small amount of money , strategically used , can substantially improve PHC .  Haiti 's experience , after more than a decade of use , indicates that incentives are an effective tool to strengthen PHC
The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .