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 .
The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China: An Impact Evaluation
In China , health care providers have traditionally been paid fee-for-service and overprescribing and high out-of-pocket spending are common . In this study , township health centers in two counties were assigned almost r and omly to two groups : in one , fee-for-service was replaced by a global capitated budget ; in the other , by a mix of global capitated budget and pay-for-performance . Performance captured inter alia " irrational " drug prescribing ; 20 percent of the global capitated budget was withheld each quarter , points were deducted for failure to meet targets , and some of the withheld budget was returned in line with the points deducted . Outcomes included appropriate prescribing and prescription cost , data on which were obtained by digitizing prescriptions from a month just before the reform and from the same month a year later . Impacts were assessed via multivariate differences-in-differences with township health center fixed effects . To reduce bias from non-r and omness in assignment , the sample was trimmed by coarsened exact matching . Pay-for-performance reduced inappropriate prescribing significantly and substantially in the county where the initial level was above the penalty threshold , but end-line rates were still appreciable ; no effects were seen in the county where initial levels were around or below the threshold , or on out-of-pocket spending in either county
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 .