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 .
Training in Complementary Feeding Counselling of Healthcare Workers and Its Influence on Maternal Behaviours and Child Growth: A Cluster-randomized Controlled Trial in Lahore, Pakistan
Malnutrition is common among children aged 6–24 months in developing countries . It increases the risk of mortality .  Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children . A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children . Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries . The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques . The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance , improving feeding practice s , and reducing  growth faltering in children aged 6–24 months . A cluster-r and omized controlled trial was carried out . The method used in this study was a replica of the method in a similar study in Pelotas , Brazil . Forty health centres were paired , and one centre of each pair was r and omly allocated to the intervention group , and the other to the control group . The Integrated Management of Childhood Illness ( IMCI ) module—‘Counsel the mother'—was used for training health workers in the health centres in the intervention group . Data from 36 paired health centres and 375 mothers and their children aged 6–24 months recruited from these health centres following consultation with health workers were included in analysis . Independent observers , masked to the intervention status , examined the performance of health workers within the first month after training . Mother-child pairs were visited at home within two weeks , 45 days , and 180 days after recruitment . Information was recorded on the feeding practice s , recall of the recommendations of health workers , and sociodemographic variables at these home-visits . Weight and length of the child were measured at each contact . The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group . The mothers ' recall of the recommendation of health workers and reported infant-feeding practice s were also significantly better in the intervention group than in the control group , even 180 days after the recruitment consultation . Growth faltering was less in the intervention group , with the largest effect observed among children in the age-group of 12 + months . These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers . Improved feeding practice s of counselled mothers can , in turn , reduce growth faltering in their children
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 .